The Right to Palliative Care

We just attended the Hospice Palliative Care Ontario 2016 Conference in Toronto. Wonderful event with nearly 800 attendees.

Much talk about PAD (Physician Assisted Dying) or MAID (Medical Assistance In Dying). The following day there was an interesting opinion piece in the Globe and Mail by Dr Tom Koch, a gerontologist and ethicist, who provides chronic and palliative consultations. The title of the article, “The next court challenge, the right to better care“.

Koch asks the question, “If the Supreme Court decision enshrines choice as a principle of Canadian justice,  then what choice are we to be offered? If it is between constant pain and an early death, most of us would prefer the latter. Expert palliative care can mitigate physical suffering in, according to experts, perhaps 95% of all cases. But at present, that level of pain control is unavailable to many Canadians. Without its surety, the choice is limited, if not empty, and justice therefore denied because a real full choices is withheld. Similarly, all agree that end stage home care and hospice care can make the last stage of an illness more than bearable. But many Canadians who would choose this, can not, it is not available. And without its insurance, the choices they are offered to care to the end are limited.”

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Advance Care Planning Day – Speak Up!

Advance Care Planning Day in Canada, and National Healthcare Decisions Day in the USA, is quickly approaching. On April 16, 2016, it’s time to speak up – and have discussions with friends and family members about your wishes for end-of-life.

Life and Death Matters created Care Planning Cookies, edible cookies with a message inside, each one intended to stimulate conversations about living well and dying well. One hospital in Ontario is ensuring that each patient receives a cookie on their meal tray, and that family and staff are given cookies with their food and beverages in the cafeteria, leading up to April 16th.

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iPanel – Conceptual foundations of a palliative approach: a knowledge synthesis

Over the past few years I have cited the iPANEL research (Initiative for a Palliative Approach in Nursing: Evidence and Leadership) as one of the most important research projects in hospice and palliative care today.

Today the iPANEL team announced the publication of their latest article – Conceptual foundations of a palliative approach: a knowledge synthesisThe article can be found here.

Please distribute this article widely! This is an open access journal, so SEND people to the LINK instead of sending the PDF. The number of hits impacts the ranking of the article on the journal’s website!

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Green Burials

Guest blog post by Susan Benesch – owner, and licensed funeral director, of Earth’s Option Cremation & Burial Services in Victoria, BC. Earth’s Option offers celebrations of life, funeral services, burial services, cremation services and specialize in green burials. They also provide a list of grief support resources and a pre-planning checklist on their website.

Green Burial has become an option available to families looking to minimize their environmental footprint when a loved one passes away. Being green and environmentally conscience has become a way of life.

What are considered alternative funeral rights and rituals?

In the past we saw traditional funerals, whereby every person was embalmed, dressed, placed in a casket and put on public display for viewing. The funeral ceremony would follow the next day with a long procession out to the cemetery. The casket would then be buried in the grave in a concrete vault and the top of the grave would have a granite headstone.

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Reflections on the 4th International Public Health & Palliative Care Conference 2015

In May 2015 I attended the Public Health and Palliative Care conference in Bristol, England. There were approximately 180 people who attended from around the globe.

There were many inspiring and innovative ideas for death education and death literacy, and many messages about compassionate communities providing care for the dying.

I found the following thoughts quite profound:

1. “Do not leave death to the experts.” – Allan Kellehear
2. “Remember that death is a social event with a medical component, not a medical event with a social component. The larger part of dying happens outside of the institution and professional care”. – Allan Kellehear
3. “End of Life Care does not begin with palliative care it begins with community. – Julian Abel
4. “Expand the team to include community as REAL partners, not just targets of care.” – Allan Kellehear
5. “Help people identify their “ring of confidence” including their friends, family and paid resources.”
6. “Put family cares/caregivers in the drivers seat, and find out what they want/need.” – Julia Verne

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20th International Conference on Palliative Care

On September 9, 2014 I was lucky enough to be able to attend the 20th International Congress on Palliative Care in Montreal, QC. There were so many fabulous speakers and I wanted to share some of the take-a-ways from the Congress with you.

Dr Balfour Mount and Kath Murray

Dr Balfour Mount and I at the Congress

Dr. Tom Hutchinson led the one day pre conference workshop titled “Whole Person Care for Persons with Cognitive Impairment”. One of the first speakers suggested “We are all cognitively impaired. Live with it – deal with it.” When we accept the cognitive impairment is part of life then we can plan for it, prepare for it, and put strategies in place. Preparing will get us further ahead than fighting it.

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The quality of death — Ranking end-of-life care across the world

Today is International Hospice Palliative Care Day.

A fascinating report published in 2010 ranked 40 countries on how they provide end-of-life care. Nations were scored in four categories including the end of life health care environment, available of end of life care, cost of the care and quality of the experience. Canada ranked 9th overall.

The report is actually a very interesting read. The report provides a global overview of palliative care including cultural, legal, economic and policy issues.

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Celebrating the Hearts and Hands of Health Care Workers

October is the month for several provinces to honour the health care workers across Canada.

I like to quote Shakespeare who said that “a rose by any other name still smells as sweet.” and a health care worker, a personal support worker, a health care assistant, by any other name is a fabulous and important and significant member of the health care team!

In Victoria we have an annual party each year to bring together and honour Health Care Assistants (in BC knowns as: HCAs, RCAs, HSWs, CHWs etc). Chartwell Ross Place generously provides their beautiful “great room” AND light snacks (THANK YOU!). A fun afternoon, the caregivers get to connect with friends and meet new ones, receive a self care treatment, a few little gifts, and almost half of the people left with a door prize last year.Students from Camosun College and Sprott Shaw college, and the managers from local agencies help with serving YOU.

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Nurses Assistants describe signs of dying among older people in a nursing home

In Sweden the Nurses Assistants provide much of the direct care, similar to Personal Support Workers (HCAs, CCAs etc.) in Canada. In this study they were interviewed and shared what they observed in the last days and hours before a person’s death. They identified clear physical changes as well as more subtle changes.
Recommendations include:

  • “Reports of signs observed by Assistant Nurses must be taken seriously,to increase the possibility of offering the best possible palliative care at nursing homes.
  • Assistant nurses must be seen as a significant part of the care team in order to take advantage of their practical knowledge.
  • Assistant nurses need to be offered continuous education and support regarding palliative care in order to develop their skills and practical knowledge.”

These recommendations are very appropriate for Canada as well. This past week I attended the Canadian Association of Continuing Care Educators (CACCE) conference in Vancouver. Discussions included the need to advocate for Health Care Workers to be recognized as significant contributors to the health care team, the need for Health Care Workers to open their mouth and provide input, and finally, discussion of ways to decrease the hierarchy in the health care team.

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Working with passion and a desire to change lives… (and having some fun at the same time…)

The past few weeks Ted and I have been in Ontario. First at the Hospice Palliative Care Ontario Conference (HPCO), and now at the National Association of Career Colleges (NACC).  In between we met with a class of PSW students with the Catholic Continuing Education School Board program (CESBA) , and leaders from Ontario Community Support Association, (OCSA) and CESBA, and a marvelous educator from Centennial College. OH, and we had the very exquisite privilege of awarding Jackie McDonald with the very first Frances Montgomery PSW Hospice Palliative Care Award.

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