End of Life Issues

1. End of Life Issues

2. Home and Community Care • The Ministry of Health considers high quality end-of-life care services to be a critical part of health care services. • Nearly 56 per cent of people who die in B.C. spend their final hours in a hospital, despite the fact that nearly 90 per cent of Canadians report they would like to stay at home during their remaining time. With good planning and appropriate services, the province believes many more people will be able to spend this time, with the support of family and friends, in the comfort of their own homes or specially designed hospices (including residential care facilities).

3. Home and Community Care • As only 10 per cent of all deaths each year in B.C. are unexpected – 75 per cent of deaths are among seniors – advance planning is vital to a well-managed health care system. And, as the ability to manage chronic diseases such as heart disease, stroke, respiratory disease and cancer improves, more British Columbians will live longer and need support at the end of their life. • By 2026, one in five British Columbians will be a senior. With an aging population, comes the need for end-of-life care planning.

4. B.C.’s Framework for End-of-Life Care • To improve the quality of end-of-life care, in 2001 the Ministry of Health engaged a panel of experts to examine how home and community care services can better serve palliative care clients. The ministry also consulted with people across B.C., family caregivers, palliative care professionals and volunteers providing hospice and other support services. Their feedback formed the basis of a broadly-circulated discussion paper.

5. Home and Community Care • Using further research-based evidence from B.C. and other provinces, the ministry has developed the policy document, A Provincial Framework for End-of-Life Care. This framework is a guide for health authorities, service providers, communities and individuals in developing and delivering services for people who are dying and their families.

6. Home and Community Care • Services • Whether a senior or young person with a serious illness, most people nearing the end of their life want to have as enjoyable a quality of life as possible in their circumstances. • End-of-life care is supportive and compassionate care provided during the remaining days, weeks or months of a client’s life. It is provided wherever the client is living -- in their home, in hospital, a hospice, residential care facility or an assisted living residence. • Specialized care services preserve the person’s comfort, dignity and quality of life.

7. Home and Community Care • Palliative Care • Palliative care services relieve, eliminate and/or control symptoms so those facing death, and their loved ones, can devote their energies to embracing the time they have together.

8. Home and Community Care • Community-based Care • Community services include palliative care co-ordination and consultation, professional nursing services, community rehabilitation services, home support and respite for the caregiver.

9. Home and Community Care • BC Palliative Care Benefits Program • The BC PalliativeCare Benefits Program supports individuals of any age who have reached the last six months of a life-threatening disease or illness and want to receive palliative care at home.

10. Home and Community Care • Eligible patients receive: • coverage of medications used in palliative care through the PharmaCare BC Palliative Care Drug Program, and • medical supplies and equipment through the local health authority.

11. Home and Community Care • B.C. residents who are enrolled in the Medical Services Plan can request that their physician assess their medical eligibility for the program and submit an application on their behalf. • For more information, see the patient information sheet (PDF 31kb). • Detailed information for physicians is available on the PharmaCare Downloads Web page.

12. Home and Community Care • Some B.C. Examples • Victoria Hospice Society, the first integrated palliative care program in B.C., has provided end-of-life care to patients and their families since 1980. Their services include expert physical care, as well as counselling, spiritual care and bereavement services. A palliative response team on South Vancouver Island supports clients in their homes. After-hours medical support is provided to palliative units and through home care nurses in Nanaimo and Victoria.

13. Home and Community Care • Richmond’s first community-based hospice, the Salvation Army Rotary Hospice House, provides home-like care during the final stages of a client’s life. The project is an innovative partnership with Vancouver Coastal Health, which covers a portion of the annual operating costs. The hospice is also funded through the assistance of donations from the Rotary Club of Richmond, community groups and individuals. Capital funding is provided by Canada Mortgage and Housing Corporation and BC Housing, under the Canada-BC Affordable Housing Agreement.

14. Home and Community Care • “Hospice care is about providing a commitment to the whole person – the physical, emotional, social and spiritual – and helping individuals who are dying to face their death with personal integrity and truly living until they die.” – Honourable Linda Reid, Minister of State for Childcare and MLA for Richmond East

15. Home and Community Care • An after-hours response pilot project, in partnership with BC NurseLine, provides advice and support to Fraser Health hospice palliative care clients and their families when regular health offices are closed. A new 11-bed tertiary palliative care unit at Burnaby Hospital acts as a regional referral centre for the health region. In addition, community-based hospices are located in Burnaby, Port Moody, Surrey, New Westminster and Mission.

16. Home and Community Care • Interior Health’s regional palliative care strategy has led to enhanced services and new hospice beds in the Okanagan, including Vernon and Penticton, and in Kamloops, located in the Thompson Cariboo Shuswap region.

17. Home and Community Care • Northern Health is working towards a palliative care network of services. The network will be a model of excellence for palliative and end-of-life care within rural and northern communities.

18. Home and Community Care • The Victoria Conservatory of Music music therapy program uses singing, instrument playing, composing, active listening and movement-to-music activities to support children, youth and adults coping with life-threatening illnesses or grieving the loss of a loved one. Music therapy can: • assist with pain management; • lessen anxiety, agitation and insomnia; • reduce depression and loneliness; • facilitate emotional expression; • encourage life review and reminiscence; • provide spiritual support; and • ease family tensions and decrease caregiver stress.

19. Home and Community Care • Useful Links Care Services and Support for Palliative Care Clients, Family Members and Friends • BC HealthGuide Program: - Provides reliable, confidential health information and advice you can trust, including: • BC HealthGuide Handbook 2005 English edition is available free of charge at local pharmacies and government access centres. This revised version contains new information on healthy aging, including tips for caregivers. • BC HealthGuide OnLine • BC HealthFiles: Available at www.bchealthguide.org or through local public health units or departments.

20. Home and Community Care • BC NurseLine: Provides 24-hour-a-day confidential health information and advice on a variety of topics, including caring for people nearing the end of life.Call toll-free in B.C.: 1 866 215-4700In Greater Vancouver: 604 215-4700Deaf and hearing-impaired: 1 866 889-4700

21. Home and Community Care • Hospital, hospice and home-based palliative care programs: Visit this link to locate palliative care resources by health authority. • British Columbia Hospice Palliative Care Association: Leadership for organizations and individuals to ensure quality of care for British Columbians faced with a life-threatening illness, death or bereavement. • Victoria Hospice Society: Physical, emotional and spiritual care and bereavement services for Victoria patients and their families.

22. Home and Community Care • Planning for the End of Life • Advance Care Planning - Advance care planning gives British Columbians the opportunity to make choices about their future personal care, including end-of-life care. It helps capable adults to prepare if the time comes when they are unable to make decisions on their own behalf. Through advance care planning, family members and health care providers are helped to understand and respect the person’s choices.

23. Home and Community CareAdvance Care Planning • Frequently Asked Questions (Ministry of Attorney General website) • Factsheet on advance directives (PDF 34 Kb) • B.C.’s health authorities are developing web-based resources on advance directives. For information, visit: • Vancouver Coastal Health (PDF ) • Fraser Health • Vancouver Island Health Authority • Interior Health • Northern Health

24. Home and Community Care • BC Transplant Society - Online or fax registration for organ donors and information on organ donations. A list of bereavement resources is also available on this website. • BC Vital Statistics - Information on steps to take when a death occurs and obtaining death certificates. • Public Guardian and Trustee of British Columbia - Information on managing an estate when there is no will or executor and on wills and estate planning.