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Hospice Palliative Care Report to Central LHIN Board

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Title: Hospice Palliative Care Report to Central LHIN Board Author: nmerrow Last modified by: hpcn.admin Created Date: 5/17/2011 8:34:29 PM Document presentation format – PowerPoint PPT presentation

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Title: Hospice Palliative Care Report to Central LHIN Board


1
Hospice Palliative CareReport to Central LHIN
Board
  • May 31, 2011
  • Dr. Nancy Merrow
  • Chair, HPC Network for CLHIN

2
Definition of Hospice Palliative Care1
. Hospice palliative care may complement
and enhance disease
  • Hospice palliative care aims to relieve suffering
  • and improve the quality of living and dying.
  • Hospice palliative care strives to help patients
  • and families
  • address physical, psychological, social,
  • spiritual and practical issues, and their
    associated expectations, needs, hopes and fears
  • prepare for and manage self-determined life
    closure and the dying process
  • cope with loss and grief during the illness and
    bereavement.
  • 1. Canadian Hospice Palliative Care Association
    Norms of Practice 2002

3
Who Needs Hospice Palliative Care?1
  • Hospice palliative care is 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.
  • 1. Canadian Hospice Palliative Care Association
    Norms of Practice 2002

4
What kind of care is it?
  • Hospice palliative care aims to
  • treat all active issues
  • prevent new issues from occurring
  • promote opportunities for meaningful
  • and valuable experiences, personal and
  • spiritual growth, and self-actualization
  • Canadian Hospice Palliative Care Association
    Norms of Practice 2002

5
When do we start Hospice Palliative Care?
FOCUS OF CARE
Therapy to Modify Disease
Hospice Palliative Care Therapy to relieve
suffering improve quality of life
DIAGNOSIS ACUTE CHRONIC
ADVANCED LIFE THREATENING DEATH
BEREAVEMENT
PROGRESSION OF DISEASE
End of Life Care
6
Current State of HPC in CLHIN
6 hospitals
2 networks
CCAC
7 Nursing Agencies
1,651,681 people
5 Cancer programs
Umpteen pharmacies
EDITH PROTOCOL
Family Doctors
3 bed residential hospice
46 Long Term Care Homes
HPC Teams
Funeral Homes
EMS
Temmy Latner Centre
12 visiting hospices
Faith Based Groups
7
Typical Patient Journey
More Chemo? Radiation?
What dose?
What is Hospice?
DNR?
Who will Take care of me?
Who should I refer to?
What is cremation? How much does a funeral cost?
Can I die at home?
8
Brief History of the Network
  • HPC Network was created in 2007 as part of the
    provincial End of Life Strategy
  • To plan, oversee and evaluate comprehensive
    hospice palliative care for the residents of the
    Central Local Health Integrated Network
  • Volunteer Steering Committee with paid
    coordinator
  • Budget 70,000

9
Challenges
  • Voluntary membership
  • Voluntary leadership
  • Limited budget
  • Coordinator position was hard to recruit and
    maintain
  • No presence
  • No accountability from or to members for action
    or involvement
  • No data

10
Successes
  • Strategic Plan
  • Environmental Scan
  • 3 Annual Networking Education Days
  • Consultation body for various projects including
    the Hospice Palliative Care Teams for CLHIN Aging
    at Home funded program

11
HPC Teams
  • Funded by Aging at Home in 2008
  • Expanded in 2010
  • Partnership between CCAC, Southlake Regional
    Health Centre, and Temmy Latner Centre for
    Palliative Care
  • Integrated the pre-existing Regional Pain
    Symptom Management Consultation Team

12
HPC Teams continued
  • Housed with small admin office at Stronach
    Regional Cancer Centre
  • Program Lead, Nurse Manager, admin assistant
  • 5 Clinical Nurse Consultants
  • Work out in community
  • Consulting with providers and clients
  • Providing education

13
HPC Team Products
  • Website
  • Average new referrals 75 per month
  • Average 300 patients on caseload at all times
  • 90 of patients dying in setting of choice
  • Average 40 ER Visits avoided per month
  • Analysis of reasons for transfer to ER
  • Analysis of reasons preference for place of death
    not met
  • In home chart

14
HPC TeamsKnowledge Transfer Exchange
  • Weekly case consultation meetings at local
    hospices
  • Education sessions at long term care homes
  • Cancer Care Ontario Symptom Guides training in
    collaboration with CCO
  • Expected Death in the Home Protocol
  • Symptom Relief Kit

15
Next Steps for HPC Teams One time funded
projects
  • Comprehensive team based education for primary
    care and long term care providers
  • Case based real time teaching and mentoring
  • 24 hour response to avoid transfer to ER
  • Research study on barriers to primary care
    involvement in HPC
  • Research study on outcomes of mentoring

16
Long Term Goals for HPC Teams
  • Physical location
  • Add physicians and psychosocial expertise to
    teams
  • Integrate physician teams
  • Enhanced 24x 7 crisis response (story)
  • Expand teams to improve access need 8 Clinical
    Nurse Consultants for full geographic coverage

17
Successes in other LHINs
  • Champlain LHIN network recognized the need for a
    comprehensive integrated program for the Ottawa
    area.
  • Undertook an extensive planning and engagement
    process over one year.
  • On line survey
  • Facilitated sessions
  • Email feedback

18
Outcomes in Champlain LHIN
  • Establishment of a regional HPC program
    accountable to the LHIN
  • A Leadership Council to over see the program
  • Formal agreements with service providers to
  • Support the objectives of the program
  • Incorporate standards and competencies
  • Establish performance indicators for evaluation
    and program planning

19
A HPC Program for CLHIN
  • Strategy, planning and research
  • Management of the HPC Program
  • Access, Performance and Accountability
  • Clinical Excellence
  • Person and Family Advisory Group
  • Community Engagement
  • Provider care and Development
  • Education and knowledge translation, capacity
    building
  • Public reporting

20
Hospice Palliative Care for CLHIN
21
Model for HPC in CLHIN
CIRCLE OF ACCOUNTABILITY
22
The Future of Hospice Palliative Care for CLHIN
Cancer centre
A Good Death
Complete Care Plan
Long term care
CCAC
Hospital
HPC Teams
Hospice
Bereavement care
Primary care
Home
Transport DNR EDITH Protocol
Home Care
23
LHIN Support
  • The Central Hospice Palliative Care Network
    steering committee unanimously recommends that
    the Central LHIN dissolve the network and approve
    the formation of a Transition Strategy Team to
    lead a planning and engagement process to create
    a comprehensive Hospice Palliative Care Program
    for the LHIN

24
Thank you !
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