HNHB LHIN Board Education Meeting February 20, 2013 Presenter: Carol McKenna, Chair, HNHB HPC Network 1
The Illness Experience What is Hospice Palliative Care The Canadian Hospice Palliative Care Association (CHPCA) National Model Key Facts The Provincial Declaration of Partnership The HNHB Hospice Palliative Care (HPC) Network System Design Priorities & Accomplishments Next Steps Success Stories 2
In the 21 st century, people are living with illness for much longer than ever before. Today, they must deal with many complex issues: • How can they get rel elief f from thei their s symptoms? • How can they carry y on on with th life e as they have known it? • How will the illness affec ect thei their r rol oles a and rel elationships? • What can be done to change the illness e experien ence? • How can they restore or maintain their capacity for meaningful and valua uable ex e exper erien ences that give quality to their lives? 3
To help patients and their families address these issues while they were dying the approach used is hospic ice p pallia liativ ive c care . In Canada, it began in the 1970s and has evolved rapidly. HPC can be applied throughout the experience of illness and bereavement to: • help patients and families improve the quality of their lives, • increase their ability to participate in therapy to fight their disease and, • potentially, prolong their lives. 4
Hospice Palliative care is no not A patient • A place • A program • 5
Hospice Palliative care is is: • provided to a patient • provided in a place • provided by health care practitioners, program, service etc. 6
HPC 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. HPC may complement and enhance disease-modifying therapy or it may become the total focus of care. HPC is most effectively delivered by an interdisciplinary team of healthcare providers who are both knowledgeable and skilled in all aspects of the caring process related to their discipline of practice. Source: CHPCA 7
HPC aims to relieve suffering and improve the quality of living and dying. HPC 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. HPC 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. Source: CHPCA 8
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The term “hospic ice p pallia liativ ive c care re” was coined to recognize the convergence of hospice and palliative care into one movement that has the same principles and norms of practice. In a consensus–building process led by the Canadian Hospice Palliative Care Association, providers, organizations and consumers joined to develop a clear vision for hospice palliative care that everyone could use. A resulting Natio ional M l Model o l of HPC represents more than 10 years of collaboration by individuals, committees, associations and governments across Canada and is based on the nationally accepted principles and norms of practice. 10
CHPCA N Natio iona nal l Mo Model o del of HPC PC Educa cati tion Pat atient an and Of Prim imar ary an and Family ily C Care Expert H Healt althcar are Pro rovid iders Advoca ocacy cy Rese sear arch on an any y of a a Number er o of lev evel els Source: The Canadian Hospice Palliative Care Association, 11 A Model to Guide Hospice Palliative Care, 2002
Care to modify disease Focus of Care Hospice Palliative Care to relieve suffering and/or improve quality of life Presentation/ Time Individual’s Death Diagnosis Illness Bereavement Acute Chronic Advanced Life-threatening End-of-Life Care 12
Over the next 40 years demand for hospice palliative care services will continue to increase. In 2004, Statistics Canada projected that the rate of deaths in Canada will increase by 33% by the year 2020 to more than 330,000 deaths per year. In Ontario, homecare patients who are hospitalized in their last month of life; 90% never leave hospital Of those hospitalized in last month of life, 33% have length of stay >14 days The CHPCA estimates that each death in Canada affects the immediate well-being of an average of five other people, or more than 1.25 million Canadians each year. Source: Seow 2009 Canadian Hospice Palliative Care Association, 2012 13
The leading causes of death in Canada are: diseases of the circulatory system (about 35%), neoplasms (tumours or cancers) (about 28%) and diseases of the respiratory system (about 10%). Hospice palliative care programs and services are beneficial for all of these groups, which total 73% of all Canadian deaths. However, 80-90% of patients currently receiving palliative care have a cancer diagnosis. In fact only 16% to 30% of Canadians who die currently have access to or receive hospice palliative and end-of-life care services depending on where they live in Canada. In 2011-12, HNHB LHIN hospitals reported 9,926 ALC days associated with patients waiting in hospital to access the preferred palliative care destination. Source: HNHB LHIN IDS DAD Sensitivity Analysis 2011-12 (January 2013) Canadian Hospice Palliative Care Association, 2012 14
DECLARATION OF PARTNERSHIP AND COMMITMENT TO ACTION Advancing High Quality, High Value Palliative Care in Ontario December 2011 15
Caregiver Supports Strengthen Capacity and Human Capital Improve Access Early Identification Public Awareness Integration and Continuity Across Continuum Measure Performance and Experience Accountability and Shared Accountability 16
Chronic disease management and palliative care are not necessarily integrated into a continuum of care that spans diagnosis to end of life to bereavement. Specific integration essentials are inadequate in most regions including: • common clinical practices and processes across sectors (including use of common tools); • shared functional and clinical infrastructures; and • common education 17
Generally Intensity Diminishes in Time based on the Individual an and their Fam amily’s Needs and Goals Health Complications Primary Care Interdisciplinary End-of-Life Investigations Pain & Symptom primary team Care Specialists Management Focus of Care A A At Established Advanced Chronic Death Risk Disease Disease Exten ended ed i inter er-prof ofession onal te team a and nd common ommon c care plan A A Controlled Chronic Diagnosis Terminal Chronic Bereavement Disease Disease Advance Care/Life Planning Options Psychosocial-Spiritual Support Specialized HPC Team-based therapy to relieve suffering Self Management Stabilized Treatment and/or improve quality of life Generally Intensity Increases in Time based on the Individual and their Family’s Needs and Goals Time Last Year of Life Last Days and Hours of Life 18
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Outcomes from introducing palliative supports in a systematic and regional manner include (Manfredi, 2000, Morrison et.al. 2008, Braiteh et. al. 2007, Hauptman et. al. 2005): Improved end-of-life care • Increased discharges from hospital • Improved patient satisfaction and reduced • hospital costs (cost-avoidance for the system) More appropriate use of therapies, treatments, • and investigations creating a decrease in variable costs (for example, in one study, following palliative care consultations, 58.1% of individuals/families decided to forego unnecessary, and costly treatments) Studies suggest quality palliative home care can reduce avoidable hospitalizations in the last months of life by 35 to 50% Current Ontario data matched against best practice and outcomes achieved in other jurisdictions suggests that we can achieve a net annual health care saving/cost avoidance of $20M $20M t to $70M $70M through reducing avoidable hospitalizations and Source: Morrison, R.S., et al. (2008). Cost Savings Associated length of stay, while improving access to With US Hospital Palliative Care Consultation Programs. Arch community-based care and reducing family burden Intern Med. 168 (16): 1783-1790. 21
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LHIN funded Palliative Care Programs/Resources: 5 Residential Hospices totaling 42 beds Specialized PC Community Based Shared Care Outreach Teams – 10 teams Palliative Pain and Symptom Management Program – 4 Consultants Interdisciplinary Community and Facility Based PC Education PC Physician Education Hospice Volunteer Visiting Program Hospice Day Programs (at Residential Hospices) 25
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