Hospice Palliative CareReport to Central LHIN Board

May 31, 2011Dr. Nancy Merrow

Chair, HPC Network for CLHIN

Definition of Hospice Palliative Care1

Hospice palliative care aims to relieve sufferingand improve the quality of living and dying.Hospice palliative care strives to help patientsand 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.

1. Canadian Hospice Palliative Care Association Norms of Practice 2002

Who Needs Hospice Palliative Care?1

Hospice palliative care is appropriate for anypatient and/or family living with, or at risk ofdeveloping, a life-threatening illness due to anydiagnosis, with any prognosis, regardless ofage, and at any time they have unmetexpectations and/or needs, and are prepared toaccept care.

1. Canadian Hospice Palliative Care Association Norms of Practice 2002

What kind of care is it?

Hospice palliative care aims to:• treat all active issues• prevent new issues from occurring• promote opportunities for meaningfuland valuable experiences, personal andspiritual growth, and self-actualization

Canadian Hospice Palliative Care Association Norms of Practice 2002

When do we start Hospice Palliative Care?

DIAGNOSIS ACUTE CHRONIC ADVANCED LIFE THREATENING DEATH BEREAVEMENT

Therapy to Modify Disease

Hospice Palliative Care Therapy to relieve suffering & improve quality of life

End of Life Care

FOCUS OF CARE

PROGRESSION OF DISEASE

Current State of HPC in CLHIN6 hospitals

Umpteen pharmacies

3 bed residential hospice

46 Long Term Care Homes

1,651,681 people

12 visitinghospices

7 Nursing Agencies

Faith BasedGroups

Funeral HomesEMS

Family Doctors

5 Cancer programs

CCAC2 networks

HPC Teams

TemmyLatner Centre

EDITH PROTOCOL

Typical Patient JourneyMore Chemo?Radiation?

What is Hospice?

Can I die at home?

Who should I refer to?

DNR?

What is cremation?How much does a funeral cost?

What dose?

Who willTake care of me?

Brief History of the Network

HPC Network was created in 2007 as part of the provincial End of Life Strategy“To plan, oversee and evaluate comprehensive hospice palliative care for the residents of the Central Local Health Integrated Network”

Volunteer Steering Committee with paid coordinator

Budget $70,000

Challenges

• Voluntary membership• Voluntary leadership• Limited budget • Coordinator position was hard to recruit and

maintain• No “presence”• No accountability from or to members for action

or involvement• No data

Successes

• Strategic Plan• Environmental Scan• 3 Annual Networking Education Days• Consultation body for various projects

including the Hospice Palliative Care Teams for CLHIN Aging at Home funded program

HPC Teams

• Funded by Aging at Home in 2008• Expanded in 2010 • Partnership between CCAC, Southlake

Regional Health Centre, and Temmy Latner Centre for Palliative Care

• Integrated the pre-existing Regional Pain & Symptom Management Consultation Team

HPC Teams continued

• Housed with small admin office at Stronach Regional Cancer Centre

• Program Lead, Nurse Manager, admin assistant

• 5 Clinical Nurse Consultants– Work out in community– Consulting with providers and clients– Providing education

HPC Team Products• Website• Average new referrals 75 per month• Average 300 patients on caseload at all times• 90% of patients dying in setting of choice• Average 40 ER Visits avoided per month• Analysis of reasons for transfer to ER• Analysis of reasons preference for place of

death not met• In home chart

HPC TeamsKnowledge Transfer & Exchange

• Weekly case consultation meetings at local hospices

• Education sessions at long term care homes

• Cancer Care Ontario Symptom Guides training in collaboration with CCO

• Expected Death in the Home Protocol• Symptom Relief Kit

Next Steps for HPC Teams – One time funded projects

• Comprehensive team based education for primary care and long term care providers

• Case based real time teaching and mentoring

• 24 hour response to avoid transfer to ER• Research study on barriers to primary care

involvement in HPC• Research study on outcomes of mentoring

Long Term Goals for HPC Teams

• Physical location• Add physicians and psychosocial

expertise to teams• Integrate physician teams• Enhanced 24x 7 crisis response* (story)• Expand teams to improve access – need 8

Clinical Nurse Consultants for full geographic coverage

Successes in other LHINs

• Champlain LHIN network recognized the need for a comprehensive integrated program for the Ottawa area.

• Undertook an extensive planning and engagement process over one year.– On line survey– Facilitated sessions– Email feedback

Outcomes in Champlain LHIN

1. Establishment of a regional HPC program accountable to the LHIN

2. A Leadership Council to over see the program3. Formal agreements with service providers too Support the objectives of the programo Incorporate standards and competencieso Establish performance indicators for

evaluation and program planning

A HPC Program for CLHIN• Strategy, planning and research• Management of the HPC Program• Access, Performance and Accountability• Clinical Excellence• Person and Family Advisory Group

– Community Engagement• Provider care and Development

– Education and knowledge translation, capacity building

• Public reporting

Hospice Palliative Care for CLHIN

CENTRAL LHINBOARD

HPC PROGRAM COUNCIL

MANAGEMENTCOMMITTEE

PLANNINGSTRATEGY &

RESEARCH

ACCESS &PERFORMANCE COLLABORATIVE

CLINICAL EXCELLENCE

COLLABORATIVE

PERSON &FAMILY ADVISORY

GROUP

PROVIDER CARE & DEVELOPMENT

GROUP

Model for HPC in CLHIN

CONSUMERS

EXPERTTEAMS

PALCARENETWORK

PRIMARYCARE

CANCER CLINICS

CCAC

LONG TERM CARE

HOMES

IN HOMECARE

TEAMS

HOSPITALPCUs

CLHINHOSPICES

HPC Program

CLHIN

CIRCLE OF ACCOUNTABILITY

The Future of Hospice Palliative Care for CLHIN

Hospital

Home

Primary care

Cancer centre

CompleteCarePlan

Long term care

Hospice

Home CareTransport DNREDITH Protocol

CCAC

HPCTeams

AGoodDeath

Bereavement care

LHIN Support

The Central Hospice Palliative Care Network steering committee unanimously recommends that the Central LHIN dissolve the network and approve the formation of a Transition Strategy Team to lead a planning and engagement process to create a comprehensive Hospice Palliative Care Program for the LHIN

Thank you !