HNHB LHIN Board Education Meeting February 20, 2013 Presenter: - - PowerPoint PPT Presentation
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
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The Illness Experience What is Hospice Palliative Care The Canadian Hospice Palliative Care Association (CHPCA)
Key Facts The Provincial Declaration of Partnership The HNHB Hospice Palliative Care (HPC) Network System
Priorities & Accomplishments Next Steps Success Stories
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In the 21st century, people are living with illness for much longer
Today, they must deal with many complex issues:
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To help patients and their families address these issues while
In Canada, it began in the 1970s and has evolved rapidly. HPC can be applied throughout the experience of illness and
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HPC is appropriate for any patient and/or family living with,
HPC may complement and enhance disease-modifying
HPC is most effectively delivered by an interdisciplinary team
Source: CHPCA 7
HPC aims to relieve suffering and improve the quality of living
HPC strives to help patients and families:
HPC aims to:
Source: CHPCA
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The term “hospic
In a consensus–building process led by the Canadian Hospice
A resulting Natio
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Source: The Canadian Hospice Palliative Care Association, A Model to Guide Hospice Palliative Care, 2002
Of Prim imar ary an and Expert H Healt althcar are Pro rovid iders
any y of a a Number er o
evel els
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12 Care to modify disease Hospice Palliative Care to relieve suffering and/or improve quality of life
Focus of Care
Presentation/ Diagnosis
Acute
Time
Chronic Advanced Life-threatening
Individual’s Death
Illness Bereavement
End-of-Life Care
Over the next 40 years demand for hospice palliative care
In 2004, Statistics Canada projected that the rate of deaths in
In Ontario, homecare patients who are hospitalized in their
Of those hospitalized in last month of life, 33% have length of
The CHPCA estimates that each death in Canada affects the
Source: Seow 2009 Canadian Hospice Palliative Care Association, 2012 13
The leading causes of death in Canada are: diseases of the
Hospice palliative care programs and services are beneficial
However, 80-90% of patients currently receiving palliative
In fact only 16% to 30% of Canadians who die currently have
In 2011-12, HNHB LHIN hospitals reported 9,926 ALC days
Source: HNHB LHIN IDS DAD Sensitivity Analysis 2011-12 (January 2013) Canadian Hospice Palliative Care Association, 2012 14
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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
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Chronic disease management and palliative care are not
Specific integration essentials are inadequate in most regions
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Diagnosis
Established Disease
Terminal Chronic Disease At Risk Death Bereavement
Self Management Stabilized Treatment Health Complications Pain & Symptom Management Interdisciplinary primary team Last Year of Life
Primary Care Investigations Specialists Generally Intensity Increases in Time based on the Individual and their Family’s Needs and Goals Last Days and Hours of Life End-of-Life Care Generally Intensity Diminishes in Time based on the Individual an and their Fam amily’s Needs and Goals
Controlled Chronic Disease
Advanced Chronic Disease
Advance Care/Life Planning Options Psychosocial-Spiritual Support Specialized HPC Team-based therapy to relieve suffering and/or improve quality of life
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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):
hospital costs (cost-avoidance for the system)
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
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 length of stay, while improving access to community-based care and reducing family burden
Source: Morrison, R.S., et al. (2008). Cost Savings Associated With US Hospital Palliative Care Consultation Programs. Arch Intern Med. 168 (16): 1783-1790.
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5 Residential Hospices totaling 42 beds Specialized PC Community Based Shared Care Outreach Teams
Palliative Pain and Symptom Management Program – 4
Interdisciplinary Community and Facility Based PC Education PC Physician Education Hospice Volunteer Visiting Program Hospice Day Programs (at Residential Hospices)
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CCAC Palliative Care - Care Coordinators (Case Managers) –
Acute Care PC Consultation Teams - ~5 EOL Complex Care Beds - 95
Emanuel House PC Supportive Housing – 10 beds JCC Supportive Cancer Care Program (CCO) MOH Alternative Payment Plan (APP) funded Expert PC
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To design and establish a comprehensive, consistent and
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Setting a Common Vision, Values, Principles, and Philosophy, Integration with Provincial Priorities Environmental scan of current resources Identification of the top issues Gap Analysis of Current State vs. Future State Identifying and establishing action plan priorities
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Identifies care settings and sectors where patients die and
Assesses these sectors’ ability to serve HPC patients/families Determines Gaps in HPC Service Capacity Builds service capacity through promoting funding/
Weaves HPC services across sectors into an integrated/
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Build HPC community capacity across the continuum of care
Implement an Advance Care Planning Strategy for HNHB Expand access and referral to HPC resources Build Long Term Care HPC capacity Expand the use of Common Tools (i.e., ESAS/PPS tools etc.) Build 24/7 Community Response Capacity Use technology as an enabler of cost-effective, integrated
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Enhanced and expanded to 10 Interdisciplinary expert
Ensuring palliative care programs are aligned and well
Aligning and expanding expert PC Physicians across the
Aligning the 5 new CCAC PC Nurse Practitioners to the
Implementing an Advance Care Planning (ACP) and Health Care
Providing HPC education across the system
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Where We Have Been en
sectors, & within each sector
Where We Are Hea eading
health system
appropriate setting of choice
management
Increase access to, and enhance resources to, interdisciplinary expert
Improve access to hospice palliative care:
Improve patient (caregiver) experience at end of life by embedding a
Advanced Care Planning (ACP)/Healthcare Consent (HCC) training for
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Randy and Donna Walton were married 33 years when Donna was
That’s where the Palliative Care Shared Care Outreach Team came in…
Though Donna passed away at age 53, Randy was thankful for the care
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“…she talked with the volunteer about how sad she was that she would not be with her children to watch them grow up – to look after them. They would not know her – her dreams for them – what she was like. As the volunteer and this young woman talked, they developed a plan. The first part was a shopping trip and very carefully they chose birthday cards for each of her children for each of their birthdays until they were 20. Then the real work began – this Mom began to write for her life. She wrote a message for each of her children, for each of their birthdays. A special note about what she was thinking about them. When she was no longer strong enough to write, the volunteer became her scribe. When all of the writing was done, each card was carefully sealed in an envelope and put away. One week later, she died. As a result of the volunteer connection, a legacy was left. Her children would know their mother – what she was like – what she hoped for them – how much she loved them.”
Mary Winkler, VON Hamilton Palliative Volunteer Service, Hamilton
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Six Nations Service Provider
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