Sense of Place

1
The Evolution of Hospice Palliative Care Policy
and Practice in Ontario, Canada
2
Introduction

• Ontario Demography Geography
• Urban vs. Rural
• South vs. North
• Local Health Integration Networks (LHINs)

Figure 1 Ontario Local Health Integration
Network Boundaries. Map available at
http//www.lhins.on.ca
3
Methods

• Review of academic grey literatures
• Preliminary timelines
• Review of timelines by key informants (n8)
• Follow-up semi-structured interviews with key
  informants
• Thematic content analysis of interview data
  (Aronson, 1994) revision of timelines by
  research team

4
Results

• Chronological list of provincial hospice
  palliative care (HPC) key milestones from 1979 to
  2009
• 1. Late1970s 1980s The Foundational Years
• 2. 1990s Increased Provincial Government
  Involvement
• 3. 2000-2009 Union of Stakeholders
• Influence of federal government
• Role of associations and advocates
• Rural lag Rural care is like a big black hole.

5
1. The Foundational Years

• Late 1970s and 1980s
• Origin of HPC in Canada
• 1979 1st community-based hospice
• Provincial associations established

6
2. ON Govt Takes Notice of HPC

• 1990s Few HPC milestones
• Education funding provided by Ministry of Health
• Health Care Services Restructuring Shift to
  community care
• Rural health service delivery challenges
  acknowledged
• National senate committee report

7
3. Stakeholders Unite for HPC

• 2000-2009
• National report Quality End of Life Care The
  Right of Every Canadian HPC funds through 2003
  Canadian Federal Health Accord
• End-of-Life Care Strategy enacted in 2005
  Networks established
• Rural education initiatives through Pallium
  (2004-2006) federal support for residential
  hospices
• Two provincial associations host first
  collaborative HPC conference in 2009
• HPC Provincial Think Tank in 2009 stakeholder
  group forms

8
Conclusion

• HPC in Ontario has evolved over the last 30 years
  and continues to move forward
• Rural areas continue to lag behind but there is
  movement taking place
• Increased efforts on integration and coordination
  of care
• HPC Networks unity of stakeholders holds
  potential