Quality Care for Progressive Chronic and Life-limiting Illness Serving Our Populations Well A briefing for local system/community leaders

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Quality Care for Progressive Chronic and
Life-limiting IllnessServing Our Populations
WellA briefing for local system/community
leaders
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Briefing Agenda

• Introduction
• View Dying For Care Towards Quality End-of-life
  Care (16 minutes)
• Discussion of key messages
• Review of CHPCA Model to Guide HPC
• Debrief about common myths, barriers and issues
  impeding quality care
• Same time, next year?

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View Dying For Care

• Dying For Care is a 16 minute video intended to
  help focus/inform dialogue locally.
• It is a compilation of insights based on
  semi-structured interviews with Hospice
  Palliative Care leaders conducted in late 2005.
• It reflects perspectives from a cross-section of
  professions and leaders from coast-to-coast.
• It has been designed principally for use by
  board-level, senior executive and senior medical
  leaders of Canadas health delivery systems.
• We will debrief at the conclusion of the video.

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Video Debriefing

• What surprised you as you watched?
• What concerned you as you watched?
• What are important messages that you believe are
  issues/resonate for you locally?
• Is there anything that you are now going to think
  about differently?

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Start with the end in mind

• What are we trying to achieve?
• Canadians should be able to live well and die as
  free of pain and suffering as possible in the
  setting of their choice, surrounded by loved
  ones.
• Adapted from
• Quality End of Life Care Coalition of
  Canada (QELCCC)

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Positioning For Change

• Need to broaden our understanding of palliation.
• Hospice Palliative Care (HPC) as introduced in
  2002 Model provides a pathway for improving care
  which addresses Chronic Progressive Illness.
• HPC as a philosophy/model of care is broader than
  the earlier palliative care services provision
  model.
• Each dying process/death event impacts at least 8
  others directly considerable hidden health
  risks/costs.
• If healthy populations is our accountability, we
  need to think differently about our abilities and
  responsibilities.

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Hospice Palliative Care (HPC)

• A philosophy of care and range of active,
  supportive services provided across several
  settings of care (home, hospital, hospice, LTC/CC
  and settings of marginalization) to enhance the
  quality of living, dying and surviving.
• Appropriate for any patient and/or family living
  with, or at risk of developing, a
  life-threatening illness due to any diagnosis,
  with any prognosis, regardless of age, and at any
  time they have unmet expectations and/or needs,
  and are prepared to accept care.

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Hospice Palliative Care (HPC)
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A Growing Need

• Around 250,000 Canadians will die this year as
  many as 165,000 could use hospice palliative care
  services.
• Not just about cancer, but other major causes of
  expected death including
• End-stage organ failure (e.g., heart, lung,
  renal)
• Neurological illness (e.g., Alzheimers, ALS, MS)
• Immunological illness (e.g., HIV/AIDS)
• Many people are living much longer with illnesses
  which will lead to an expected death, often with
  pain/suffering.
• At present less than 15 of Canadians have access
  to hospice palliative care services in Canada.
  Rural and remote Canada is generally doing much
  worse than most cities.

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The Current Reality

• Canadians are living longer, Baby Boomers are
  aging - if we arent meeting the needs today
  what will we do in 20 years?
• 33 more deaths by 2020.
• Most Canadians say they would like to die at home
  or stay at home as long as possible yet 75 die
  in acute care beds or long term care facilities
  (2000).
• Increased use of acute beds, unnecessary pain and
  suffering, and misuse/overuse of health delivery
  system when families are not supported with
  quality services.

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Breaking Down Barriers

• Quality in HPC service design is best guided by
  seeing the misuse, under-use and overuse of
  system resources.
• Specific initiatives to improve continuity of
  care across home, hospital, hospice,
  long-term/continuing care and other
  community-based settings is crucial.
• Improving linkages between family practice
  locally and specialists at referral sites is
  essential, especially when serious illness
  transitions to life-limiting illness.
• Earlier engagement of patients/families in
  practical and advanced care planning is a key
  building block.
• HPC philosophy part of the culture/all services,
  with access to palliative services and supports.

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Same Time, Next Year

• What specific, tangible things would you like to
  look back and say we have achieved this time next
  year?
• Some starting points.
• A local/regional inter-agency HPC Council or
  committee (improving community-based care across
  settings).
• A local/regional HPC renewal project
• A local/regional advanced care planning awareness
  campaign
• Quality improvement project linked to
  accreditation processes
• Local medical staff and staff engagement/education
  in improved care coordination/issues
  management/pain symptom skills.

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Closing Thoughts

• Changing our local/regional cultures of care will
  take time and a concerted effort.
• Earlier and better engagement of care for those
  with progressive chronic and life-limiting
  illness is essential to the citizen confidence in
  knowing the system will be there when they and
  their families need it.
• If we are thoughtful and design HPC well, we will
  not only do the right thing, but likely manage
  our scarce health care dollars and human
  resources much better.
• The local/regional systems, services and supports
  that we create today are the ones that we and our
  loved ones will also live and die by

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A Starting Point for More Info

• Canadian Hospice Palliative Care Association
  (CHPCA)
• www.chpca.net (see CHPCA Marketplace link)
• Canadian Virtual Hospice
• www.virtualhospice.ca
• End-of-Life/Palliative Education Resource Centre
  (US site)
• www.eperc.mcw.edu
• Living Lessons (Increasing awareness of HPC in
  Canada)
• www.living-lessons.org