Throughout the ages, death was a common event, occurring in every age group, a part of everyday life. Now death is somewhere off in the future because people are living much longer.
While a long life can be a good thing, the ending, often, is not. In the affluent parts of the world, most people die after years of illness and disability. Many die confused and in pain. With congestive heart failure and chronic obstructive lung disease, patients slowly deteriorate over years. With dementia, the disease may progress for 10 years prior to death. Cancer can be much faster: months as opposed to years.
Everyone should live and die in peace, with dignity, free of pain, surrounded by loved ones, in the setting of their choice.
Unfortunately, this may be difficult to achieve. More than 70 per cent of Canadians die without access to such care, and only a minority dies at home.
The majority do so in a hospital or nursing home. There is a general lack of palliative care facilities and services, although this is slowly improving. Canadians rarely discuss death or prepare for the end of life. Many doctors feel equally uneasy to initiate the difficult conversations. Thus the end often comes as a surprise, without preparation, without the opportunity to say goodbye.
Sudbury is better off than many communities. We have a hospice run by an awesome staff. But it is bursting at the seams. Maison McCulloch Hospice has had an occupancy rate of 94 per cent since opening its doors in September 2008. Of those wanting to come to the hospice, 30 per cent die prior to admission, due to the lack of available beds.
The hospice has gradually broadened its complement of services and now supports an additional 1,000 clients in the community annually, through its Shared Care Team, Visiting Hospice Service and Grief Services.
The Shared Care Team’s six nurses offer telephone advice 24 hours per day, seven days a week to families caring for loved ones at home. They also assist with the Symptom Management Clinic at the Northeast Cancer Centre, nurse practitioners at Community Care Access Centre and palliative physicians.
The Visiting Hospice Service provides visiting volunteers. They make house calls and offer home support. Palliative care does not necessarily end when someone has died. Family members may need support as they grieve the loss of a loved one: thus the need for Grief Services.
These initiatives have been highly successful. But the programs cannot grow beyond their current capacity due to limited physical space. The time has come to expand.
The expansion project will add more residential hospice beds, new short-stay respite beds and a large multi-use area.
The plan is to:
- Focus on the needs of families who are caring for patients at home: offering them short-term relief, plus education, to prevent caregiver burnout.
- Support the training of a broad range of health care providers: medical students and residents, nurses and personal support workers, volunteers, and of course, caregivers and family members.
- Accommodate pediatric end-of-life care.
- Provide crisis management for incidents that can be managed at home with expert help and so decrease Emergency Department visits and hospital admissions. Organizations like Family Health Teams, Nurse Practitioner-led clinics, and Long-Term Care facilities will also benefit.
This is an ambitious mandate. Please support financially their expansion.
Dr. Peter Zalan is president of the medical staff at Health Sciences North. His monthly column tackles issues in health care from a local perspective. If you have a question for Dr. Zalan, email it to email@example.com.