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May ICE Team Meeting: Hamilton, ONT Project 1: Policy

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May ICE Team Meeting: Hamilton, ONT Project 1: Policy & Service Analysis Team: Richards, Whitfield, Williams, Kelley Trainees: Gillis Associate: Summers – PowerPoint PPT presentation

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Title: May ICE Team Meeting: Hamilton, ONT Project 1: Policy


1
May ICE Team Meeting Hamilton, ONT Project 1
Policy Service Analysis
  • Team Richards, Whitfield, Williams, Kelley
  • Trainees Gillis
  • Associate Summers

2
Rationale
  • a comprehensive historical review (1970 to
    present) of policies and key events impacting the
    design and delivery of P/EOL care
    programs/services in rural Canada
  • systematically captures at national/provincial/loc
    al levels, the public policy/services that are
    within the domain of rural P/EOL care in the
    jurisdictions of PEI, Quebec, Ontario, Manitoba,
    Saskatchewan, Alberta
  • provides the foundation for a range of research
    projects making up the ICE Program

3
Methodological Approach
  • modeled after Springate-Baginski and Soussans
    (2001) methodology for policy process analysis ?
  • includes a documentary analysis which informs a
    policy/program trajectory, which is then
    confirmed and elaborated on via key-informant
    interviews in each provincial jurisdiction
  • National overview captured via 3 key-informant
    interviews

4
Summarized Policy Analysis Stages (adapted from
Springate-Baginski Soussan, 2001)
  1. Define Key Policy Milestones
  2. Explore Wider Policy Governance Context
  3. Examine Key Policy Issues
  4. Understand the Policy Development Process and its
    Outcomes
  5. Analyze the Implementation Process
  6. Consider the Future The Longer-term View

5
Analytical Approach
  • Modification of the traditional
    constant-comparison approach
  • Three data types used
  • documents for documentary review,
  • policy/program time-line or trajectory produced
    from documentary review, and
  • key-informant interview data (analysed using
    thematic analysis)
  • Interview data, compiled as a set for each
    jurisdiction, provided a reinterpretation of the
    timeline and documentary review
  • Data integrated via cross-referencing by theme

6
The National Scene
  • Thematic Results
  • Current State of P/EOL Care in CND
  • Characterized as underdeveloped fragmented
  • Reasons for above
  • Policy Issues Pallium project identified
  • Role/Influence of Politicians
  • Turning Points
  • Unfinished Business
  • Future Issues/Concerns ?

7
6. Future Issues/Concernsor what we (ICE) may be
able to influence
  • Meaning of rural specific to P/EOL services needs
    definition
  • Partnerships needed between
  • Different levels of govt (prov., fed., other)
  • Govts and employors
  • All service practitioners involved in order to
    achieve an integrated approach
  • Change in care models, system organization care
    practices
  • continuity across settings
  • model requiring training across settings/systems
    and professions/services
  • Recognition of a wide range of diseases (chronic
    and other)
  • Enhanced local community development in order to
    best co-ordinate concerns and engage all parties
    involved (family caregivers, volunteers,
    churches, community resources, etc.)
  • Recognize a population health approach in P/EOL
    (patient, family, community, geographies)
  • Advocate for above funding via a national
    coalition

8
Prince Edward IslandImportant turning points
  • Hospice Palliative Care Association of Prince
    Edward Island (PEI)
  • In response to grassroots pressure, the first
    palliative care program was created within the
    same year
  • In conjunction with concerned citizens, pushed
    for further development of a distinct P/EOL care
    program
  • Creation of the first 8 beds for palliative care
    on PEI at the Dr. Eric M. Found Health Center
  • Continue to improve palliative care across PEI
    concerned citizens met with government officials
    to discuss government responsibilities concerning
    P/EOL care

9
Prince Edward IslandImportant turning points
  • Eleanor Davies President of Island Hospice
    Association
  • Re-evaluated the state of P/EOL care and composed
    a proposition paper in 1995
  • Puts forward recommendations and suggests an
    integrated palliative/hospice care service
  • From her attempts to improve the existing
    programs, major progress was made within five
    years

10
Prince Edward IslandImportant turning points
  • PEI and Nova Scotia (NS) propose a Rural
    Palliative Home Care Model
  • The trial program in West Prince county (PEI)
    became a model program for the rest of Canada
  • After the success of this program, P/EOL care
    programs were created in every county of PEI

11
Prince Edward IslandCurrent successes and
challenges
  • Successes
  • Approximately 1000 health care workers have been
    trained through the Support Worker Training
    Program at Holland College (mandatory for some)
  • Challenges
  • No Island-wide policy on P/EOL care
  • Lost the Government Coordinator position

12
QuébecImportant turning points
  • The establishment of palliative care houses (PCH)
    in many regions across Québec
  • Allowed P/EOL services to be taken out of
    institutions
  • Allowed P/EOL services to be more accessible in
    rural and remote areas

13
QuébecImportant turning points
  • Foundation of the palliative care units at the
    Notre-Dame Hospital and Maison Michel-Sarrazin
  • Notre-Dame Hospital acts as a resource for the
    Montréal region by providing training and
    internship opportunities for personnel working in
    P/EOL care
  • The Maison Michel-Sarrazin fulfills the same
    functions for the Québec city region (only
    government-funded PCH)

14
QuébecImportant turning points
  • The desire of P/EOL care workers to see policy
    changes
  • Creation of the Palliative Network by many P/EOL
    care centers to act as a resource for mutual
    assistance
  • Pushed for change and the creation of policies by
    influencing the Minister of Health, the
    Honourable Pauline Marois

15
QuébecCurrent successes and challenges
  • Successes
  • PCHs allow people in rural areas to remain at
    home while receiving P/EOL care
  • Challenges
  • Government funding to sustain PCHs

16
OntarioPolitical Context
  • government is largely hands-off, following lead
    of other provinces, committing funds only late
    into the process
  • Managed competition introduced in 1996 has a
    somewhat negative affect on rural-based
    practitioners
  • funding and policies for Health services in
    Ontario tend to be the same, whether it be
    Toronto or remote

17
OntarioKey Milestones
  • Regional Health offices control their own
    palliative care policies (thus different across
    province). Reporting to province begins in
    2006.
  • Cancer Care Ontario adds Palliative Care to its
    mandate in 2004
  • Physicians to be paid for in-home palliative
    care services (goes provincial in 2007, 8 years
    after Toronto pilot)

18
OntarioFactors Contributing to Overall Success
  • Federal monies, polices and reports
  • several non-government organizations in
    Ontario that do Palliative Care
  • dedicated individuals across the province

19
Alberta
  • palliative care has sort of rolled out in
    Alberta as an urban to rural phenomenon- where
    the urban programs have developed and gotten
    themselves in a position to sort of- get the job
    done- and then the rural programs have largely
    sort of developed or been modeled after that
    (AB04, p.1)

20
AlbertaPolitical Context
  • History of strong individual initiative and
    leadership
  • Decrease of Regional Health Authorities in 2003
  • Implementation of Pallium Project in Alberta.

21
AlbertaKey Policy Issues
  • Lack of rural focus
  • Lack of Home Care services
  • service access
  • specialized knowledge
  • predictability and continuity
  • Burdened acute care system
  • small hospitals end up providing a lot of end of
    life care services because there is no
    hospice-level care in most rural communities
    (AB04, p.10)
  • Only adequate long term care system.

22
AlbertaFactors Contributing to Overall Success
  • Available funds at pertinent times e.g. having
    the right people in the right places at the right
    time (AB02, p.11)
  • Access to well-developed expertise and leadership
    by physicians and nurses
  • Use of an integrated model of palliative care
  • Some government commitment.

23
AlbertaKey Milestones
  • Commitment by government and the voluntary sector
    to advance palliative care policies and programs
  • A history of success in palliative care (success
    begets success)
  • Recent use of tele-health for consultation and
    care in rural areas
  • Ability to provide palliative care services in a
    variety of environments.

24
Saskatchewan
  • There is still such a desire in rural areas to
    die close to home or in ones communitywe avail
    that for anybody who lives in an urban
    settingbut we are not that respectful of folks
    in rural areaswe ship them out and force them to
    leave their home community.
  • That is not a good thing
  • (S04, p.5)

25
SaskatchewanPolitical Context
  • Variations in funding for services people from
    reserves (Federal vs Provincial)
  • Lack of flexibility in rural palliative care
    service delivery and related policies
  • E.g. bed protection we are not willing to turn
    that one bed over to a palliative bed for a short
    period of time so that person who actually lives
    in that community could actually die there (S04,
    p.5)
  • thats where the person wished to die but we
    wouldnt allow the person to die there because it
    was in another jurisdictionregional
    boundaries!(S04,p.10)

26
SaskatchewanKey Policy Issues
  • Lack of palliative care/end of life related
    awareness and education by
  • Government
  • Public
  • Lack of palliative and end of life care expertise
    in rural communities
  • Rural (is not) and needs to continually be
    addressed, to always ask
  • how do rural people have access to that
    service? (S04, p.9)
  • New models for rural palliative care and creation
    of new standards to determine needs of PC/E of L
    workers.

27
SaskatchewanKey Milestones
  • When province shifted to Health Regions
  • The creation of the Guidelines for Development
    of Integrated Palliative Care Services in 1994

28
SaskatchewanKey Obstacles to Policy Success
  • Geographic distances and low density population
  • Getting clinical resources (expertise) to rural
    areas
  • Using a unique rural model
  • you cant take the city and just plunk it into
    the rural (S04, p.4)
  • Urban experts not viewing palliative care from a
    community developement view
  • it was, we are the experts and we can tell you
    what to do to fix all this (S04, p.4)
  • Silo-ing of health care professions yet
    palliative care requires a team approach

29
SaskatchewanFactors Contributing to Overall
Success
  • Palliative care education provided in rural and
    remote areas as a result of Pallium project
  • That palliative and end of life care is an
    integrated model
  • working together to assist the family and the
    client to get the services they need where they
    need it and where they wish to have it (S06,
    p.8)
  • we are one of the truly integrated services in
    Canada (S06, p.1)
  • 2004-Health Research Strategy-more focus on rural
    with attached resources to develop rural
    expertise
  • Community Advisory Boards
  • - sometimes if they are really squeaky, they
    can get things done that we didnt initially plan
    for(S04, p.9).
  • The Rurban Initiative

30
Manitoba
  • palliative care here is uneventhere is
    still tremendous variation across the
    regionsthere is a lot of inconsistencyand we
    are behind other provinces (M05,p.3)

31
Manitoba(very preliminary insights-in progress)
  • Milestones/Turning Points
  • Winnipeg-1974 the 1st hospital in Canada to
    create a palliative care program
  • that has hada big impact. There are a lot of
    people who have died over the years in that
    palliative care unit. That has absolutely been
    positive (M05, p.4)
  • 1974-Province wide home care prgm.
  • providing care in rural communities as well as
    in the cities(S01, p.3)
  • Palliative Drug Access Program (2002) allowed
    people to die at home-it offset costs incurred
    outside hospital e.g. drugs
  • we really had in a sense a perverse incentive to
    hospitalize people because the drugs were covered
    in the hospital (M05, p.2)
  • 2002-Provincial funding for Palliative Care
    Networks Palliative Care Crdn. in each health
    region its put palliative care on the map in
    the regionsits a good grassrootsfrontline
    force (M05, p.2)
  • Key initiatives driven by individual leadership
  • The impact of certain initiatives still unknown.

32
to be continued
  • Once all jurisdictions complete, will determine
    commonalities/variations and determine the assets
    and challenges in each
  • Reports will be written and distributed to ICE
    members, as they correspond with field sites
    end of summer 07
  • Dissemination includes conferences (CHPCA) and
    peer-reviewed papers
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