As published in The Erin Advocate
The certainty of eventual death may bind us all together, but thinking about how and where we would prefer it to happen is a difficult process. Actually discussing our choices for end-of-life health care with family and friends is even harder.
The Waterloo Wellington Local Health Integration Network (WWLHIN) Board of Directors has approved an investment of $1.2 million over three years to help individuals create a personal Advance Care Plan (ACP) – while they are still capable of doing so.
Health care workers will be trained to give patients and families an opportunity to consider what medical and social care a person would prefer, or refuse, during a crisis or period of time when death is expected. An ACP is a holistic record of a person’s needs and wishes, in a standardized format that is consistent with Ontario law.
“Improving end-of-life care is a significant priority,” said WWLHIN Chair Joan Fisk. “One of the key components of improving this care is engaging more residents in a conversation about their end-of-life care wishes.”
The initiative will be led by the Hospice of Waterloo Region, but apply to all of Wellington County as well.
According to a 2013 survey, 55% of Canadians had never had a discussion with a family member, doctor, lawyer, friend or financial advisor about their end-of-life care preferences.
“We know that when asked, many residents would prefer to die at home surrounded by their loved ones rather than in hospital,” said Bruce Lauckner, CEO at the WWLHIN.
“Unfortunately, this isn’t happening as often as it could. Improving Advance Care Planning practices in Waterloo Wellington will help more residents experience the end-of-life care that best matches their wishes.”
While a majority of people say they want to die at home, about 70% die in a hospital.
Dying at home may appear preferable, but in some cases it is not practical for providing the care and comfort that a person may need. Hospices can provide a good alternative, but there are only 271 hospice beds in Ontario. The Auditor-General says 1,080 are needed.
Clearly, as part of its mandate, the LHIN is spending money in hopes of saving even more. Dying in a hospital is an expensive process, and as the baby boom goes bust, there will be a huge strain on the health care system.
According to a report by Health Quality Ontario, by 2026, the number of Canadians dying will increase by 40%, to 330,000 every year. Of hospitalized Canadian elderly, 70% reported wanting comfort measures rather than life-prolonging treatment, but more than two-thirds were admitted to intensive care units.
The Auditor-General recently reported that palliative care costs $1,100 per day in an acute-care hospital bed, $630 to $770 daily in a palliative-care unit, $460 in a standalone hospice, and about $100 when at-home care is provided.
The process of dying will never be an easy one, but it is within the capacity of our health system to provide consistency in the provision of high quality palliative care for everyone who needs it, and better support for families in their time of need.