Solutions for palliative care

The OMA is calling for increased access to palliative care, as way to ease the strain on the health-care system overall. In this podcast, Dr. Sandy Buchman, a palliative care physician and medical director of North York General Hospital's Freeman Centre for the Advancement of Palliative Care, talks about how palliative care could be delivered more effectively, how increasing hospice beds would save money, and the need for better human health resource planning.   

Transcript

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Georgia Balogiannis: In this podcast the Ontario Medical Association looks at current issues of interest in health care. Spotlight on Health gives you all the straight talk. We're Ontario's doctors and your health matters to us.  I'm Georgia Balogiannis for the Ontario Medical Association. 

Ontario health care system is experiencing unprecedented backlogs, and palliative care may provide a solution. Dr. Sandy Buchman is the Freeman family chair in palliative care at North York General Hospital and a past president of the Canadian Medical Association. He discusses the steps that must be taken to strengthen the provinces pallative care network to benefit all Ontarians.

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 Dr. Sandy Buchman: Thank you for the opportunity to speak to you today about how palliative care can be part of the solution that's facing the backlogs in our health care systems, in our emergency rooms and in our acute care settings. I think palliative care can really make a difference, and the solutions that I'm going to propose are actually part of the OMA five point plan to be referred because they had input and we've been talking about this for a long, long time, pre-pandemic, I might add and it's only gotten worse, of course during the crisis.

So one of the issues is how can we improve palliative care in community settings so that it kind of takes the pressure off our acute care hospitals. Palliative care can be delivered very effectively in community. My best estimates are that seventy percent can actually be delivered within a primary care setting with palliative specialists and teams backing up primary healthcare teams.

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 Dr. Sandy Buchman: I'm the medical director of the Freeman program in North York. Our Ontario health team, North York Toronto health partner, serves over five hundred thousand people within the highly urban and dense area of North York. We have about a million people. We do not have one Hospice residence within North York. As a matter of fact, in the city of Toronto there is only actually one adult hospice residence in Kensington Health. There is a hospice where I worked very effectively for people experiencing homelessness, and there's Casey House for dealing with people with HIV Aids, but otherwise there's no other hospice residence where people can go for cost-effective end-of-life care.

As an example, the last data that we have was from the Auditor General's Report of December 2014, so we can scale it up. But at that time it cost the hospital eleven hundred dollars a day to keep that patient in hospital. In a hospice residence, it costs four hundred and fifty dollars a day.

About seventy thousand people die in hospitals a year, and say, we took half that, 35-thousand that could be looked after in community, say, in a hospice setting. We would be saving five hundred and fifty dollars a day per patient. Average length of state 21 days times times whatever tens of thousands. This works out to hundreds of millions. 

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Dr. Sandy Buchman: I decided, with a group of concerned citizens to build a hospice in North York. We started about six years ago. We've got a vigorous campaign. We've raised eighteen million dollars, and now, with inflation, it looks like we're going to have to raise another nine, ten million.

We have land in North York. We have our permits. We're kind of ready to go. The Government of Ontario through a lot of advocacy is giving us two hundred thousand for ten-bed hospice, two million dollars. Why, for essential health care like this must it be so charitable? 

In other words, there's no planning. So we're advocating for a whole network of hospice and end-of-life care that can be very cost-effective, and give the quality of care that patients need.

In addition, in my large area of North York, we have no palliative care unit, so they are usually within the institutions, as opposed to hospice, which is more home-like. But they also provide end-of-life care and interventional symptom management that can really help people during this phase of life.

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Dr. Sandy Buchman:  We also believe that we should really be enhancing palliative care services and supports at home. Right now we have this series of inter-professional teams, but it's inequitable across the province. It's really important to get those services everywhere in the province and we're having shortages in a community, too. I had a recent case of a patient at the end of life, the system well promised under the family, who was struggling to take care of their elderly parent 56 hours a week. We could not find a personal support worker or other support for this for this patient and the family was - it was difficult we did everything we could to keep these family going, so that the patient could remain at home, in the care of her of her loving family.

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Dr. Sandy Buchman: Another major solution is about our long-term care. We saw the tragedy of the pandemic and long-term care, and the number of people that were lost. We see these patients sadly showing up in emergency rooms and then getting admitted to hospital for care, because there may not be another place for them. We're advocating for increased supports of our elderly and senior patients in the community through a couple of mechanisms, team-based care in the community. We have one at the Northwest General, where we provide supportive care to patients with a non-malignant disease in the larger community.  We support their primary care team.

We have huge fantastic numbers that show how we prevent emergency room visits, and we prevent hospital admissions because we have these conversations. What are their goals of care? What do they want? Are they oriented towards comfort care? Integrating a palliative care, approach into our long-term care facilities can make a huge difference in caring for patients, comfort-oriented care in their home, and preventing these patients showing up in emerg, and then ending up as alternative level of care.

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Dr. Sandy Buchman: Palliative care is a great example of inter-professional care. Nurse, practitioners, nurses, personal support workers, social workers, physicians we all work together in the community, and we have planning for this we have no health human resource planning in the region, in the province, and frankly in the country, and we have to do much better at thinking about our health human resources, particularly in palliative care.

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