Palliative Care - General Overview, WRHA Program, Opportunities to Support Rural/Remote Communities Mike Harlos MD, CCFP(PC), FCFP Professor and Section Head, Palliative Medicine, University of Manitoba Medical Director, WRHA Adult and Pediatric Palliative Care Nov. 1, 2017

The presenter has no conflicts of interest to disclose Disclosure The presenter has no conflicts of interest to disclose

Objectives Provide a general description of palliative care Provide an overview of the WRHA Palliative Care Program Explore how the development and provision of palliative care in rural/remote communities might be supported

An anticipated death should be a family and community event with the peripheral support of health care, rather than a medical event with peripheral involvement of family and community.

Palliative care is comfort-focused care and support for those affected by life- limiting illness – the patient, their family, their health care providers, and particularly in small rural and remote settings, the community.

Elements of Palliative Care attention to comfort and quality of life care is grounded in the “personhood” of the patient who they are (or perhaps who they wish they had been, or who they hope to be) their values, priorities, goals consideration of the impact of the illness on family, friends, community supporting involved health care providers with the emotional, ethical, and technical complexities of care Arguably, these should be core elements of all health care Palliative care includes the added context of a life-limiting illness

A palliative approach should be a thread in the tapestry of all health care - how dominant the thread is depends on the context, goals of care

Role of the Health Care Team Anticipate predictable challenges Communicate with patient/family Formulate a plan for care

Increase capacity through education, advocacy, Program development involves defining services that can be carved out of a broad philosophy of care with limited resources Formal Services Palliative Care as a philosophy of care Resources Increase capacity through education, advocacy, partnerships

WRHA Palliative Care Program Two streams of service delivery: Registration on Program Consultative Services

Acute Palliative Care Units St. Boniface Hospital 15 bed unit Access to tertiary care services Riverview Health Centre 30 bed unit (2 beds currently closed) Long term care facility

Hospice settings in WRHA Grace Hospice 12 beds in stand alone facility near Grace hospital RN staffing 24/7 Limitations in care that can be provided Jocelyn House 4 beds in split-level home in St. Vital Staffing – LPN/HCA with RN nurse manager

Care at Home Majority of patients on Palliative Care program are in the community Palliative patients in community have same service limitations as all Home Care clients HCA and PSW services provided by Home Care Program Families/caregivers must be very involved in providing care

How Might WRHA Palliative Care Help? Will need to be guided by engagement with each community, listening to their unique priorities and goals Some possibilities: Contribute to the work of the new Shared Health Services Manitoba in improving provincial access to palliative care Collaborate on educational initiatives Participate in initiatives to provide clinical palliative care services Contribute to guidelines/protocols

Guidelines Developed For Long Term Care Settings Might be adaptable for use in rural/remote settings

Documents For Planning and Supporting Palliative Hospital Discharges Into Remote First Nations Communities

Tools 3 key components: Guideline Care Plan Checklist