Much needed palliative hospice care may well become a reality for Elgin county, but the appearance of dedicated beds is unlikely before 2019.
However the groundwork has begun with a request for proposal (RFP) out for tender seeking a consultant to complete a feasibility study for a hospice facility to serve St. Thomas and Elgin county. With no hospice beds, it has been identified as an in-need area.
In a presentation to city council last week, Lisa Penner palliative care lead and clinical co-lead with the South West Local Health Integration Network (South West LHIN) advised the provincial government is being urged to add 200 hospice-care beds.
“The auditor-general released a report in 2015 that identified recommendations to improve the delivery of palliative hospice care,” advised Penner.
“It also identified the value of 200 new hospice-type care units to be spread across the province. In the South West LHIN, we have been working with the minister of health and the province to leverage as many of those beds as we are able to.”
Penner noted in the South West LHIN there is a need for 49-66 residential hospice beds. Currently there are 27
“We have communicated to the province Huron-Perth, Grey-Bruce and Elgin county are our high-priority areas,” said Penner. “And we’ve been working with the Ministry of Health . . . to plan out what that will look like for each community and make sure the model is going to be sustainable.”
For Elgin, that planning process is now underway, stressed Penner.
“A small sub-committee is working through what a residential hospice would look like in Elgin county. Right now we have an RFP out for tender for a consultant who will complete a feasibility study and determine best location, the need for sustainability and the fundraising model that would be supported across Elgin county.”
The feasibility study should be completed by July of this year, added Michele Harris, executive director, Elgin Hospice Palliative Care Collaborative and administrator at Bobier Villa in Dutton and Elgin Manor in Southwold.
“The feasibility study will be the foundation for the sub-committees to make informed decisions and take back recommendations to the Elgin collaborative, then the South West LHIN collaborative and then on to the (South West LHIN) board for consideration.”
The preferred model for St. Thomas/Elgin would be a hospice able to accommodate six to ten beds.
As a stop-gap, Elgin and Oxford counties last year received what are known as hospice palliative care outreach teams.
“That team is available 24 hours a day, seven days a week to provide service in a person’s home,” said Penner. “It’s really for individuals who want to remain in their home for palliative care.”
The outreach teams are comprised of “six physicians and six nurse practitioners along with other service providers to support palliative and end-of-life care . . . and also to support dying in the client’s place of choice,” added Harris. “Whether that’s hospital, home or hospice.”
Funding has also been made available to the Elgin collaborative, said Penner.
“We have received $100,000 in funding – $50,000 from the Ontario Palliative Care Network and $50,000 from the South West LHIN – to start building up the expertise in communities where we plan to build hospices.”
So when and how would an individual and their family or caregivers benefit from palliative care. It comes down to one simple question, stressed Penner.
“If I was a healthcare provider, would I be surprised if this individual died within the next year? If the answer is ‘No’ then palliative care needs to be invoked.
In the past, we’ve done it as an end-of-life means of palliative care. At that point, it’s too late. So often, the individual is unable to leverage the benefits of palliative care programs.
“Palliative care needs to start at the time somebody is identified with a chronic disease. At that point, hospice palliative care services can begin. And it’s really about having conversations with individuals, asking ‘If something ever happened to you, what are your wishes, where would you like to be and who is your substitute decision maker?'”
In addition, the aim is to reduce the reliance on emergency department beds in a hospital, said Penner.
“We would also look at avoiding admission into hospital. Not only is that a costly endeavor for our overall system, it’s also not the best place to be. Ninety per cent of individual surveyed across the province who were on their palliative care journey did not want to be in hospital, they wanted to be at home.
“So how do you build a system that accommodates that and keeps individuals in their home as long as possible. And if that’s not possible, maybe because they don’t have support and loved ones to help them at home, then a hospice would be as close to a home-like setting as possible.”
The ultimate goal is to have all hospices in the province follow a centralized model, stressed Penner.
“We want to look at partnerships and integration that will take place, not only with the residential hospice and internal services but also with the hospital and long-term care homes . . . for a seamless transition so that individuals will go from hospitals back to long-term care or over to a residential hospice.”