Hospice Palliative Care Report to Central LHIN Board May 31, 2011 Dr. Nancy Merrow Chair, HPC Network for CLHIN

Definition of Hospice Palliative Care 1 Hospice palliative care aims to relieve suffering and improve the quality of living and dying. Hospice palliative care strives to help patients and families: address physical, psychological, social, spiritual and practical issues, and their associated expectations, needs, hopes and fears prepare for and manage self-determined life closure and the dying process cope with loss and grief during the illness and bereavement. 1. Canadian Hospice Palliative Care Association Norms of Practice Hospice palliative care may complement and enhance disease

Who Needs Hospice Palliative Care? 1 Hospice palliative care is appropriate for any patient and/or family living with, or at risk of developing, a life-threatening illness due to any diagnosis, with any prognosis, regardless of age, and at any time they have unmet expectations and/or needs, and are prepared to accept care. 1. Canadian Hospice Palliative Care Association Norms of Practice 2002

What kind of care is it? Hospice palliative care aims to: treat all active issues prevent new issues from occurring promote opportunities for meaningful and valuable experiences, personal and spiritual growth, and self-actualization Canadian Hospice Palliative Care Association Norms of Practice 2002

When do we start Hospice Palliative Care? DIAGNOSIS ACUTE CHRONIC ADVANCED LIFE THREATENING DEATH BEREAVEMENT Therapy to Modify Disease Hospice Palliative Care Therapy to relieve suffering & improve quality of life End of Life Care FOCUS OF CARE PROGRESSION OF DISEASE

Current State of HPC in CLHIN 6 hospitals Umpteen pharmacies 3 bed residential hospice 46 Long Term Care Homes 1,651,681 people 12 visiting hospices 7 Nursing Agencies Faith Based Groups Funeral Homes EMS Family Doctors 5 Cancer programs CCAC 2 networks HPC Teams Temmy Latner Centre EDITH PROTOCOL

Typical Patient Journey More Chemo? Radiation? What is Hospice? Can I die at home? Who should I refer to? DNR? What is cremation? How much does a funeral cost? What dose? Who will Take care of me?

Brief History of the Network HPC Network was created in 2007 as part of the provincial End of Life Strategy “To plan, oversee and evaluate comprehensive hospice palliative care for the residents of the Central Local Health Integrated Network” Volunteer Steering Committee with paid coordinator Budget $70,000

Challenges Voluntary membership Voluntary leadership Limited budget Coordinator position was hard to recruit and maintain No “presence” No accountability from or to members for action or involvement No data

Successes Strategic Plan Environmental Scan 3 Annual Networking Education Days Consultation body for various projects including the Hospice Palliative Care Teams for CLHIN Aging at Home funded program

HPC Teams Funded by Aging at Home in 2008 Expanded in 2010 Partnership between CCAC, Southlake Regional Health Centre, and Temmy Latner Centre for Palliative Care Integrated the pre-existing Regional Pain & Symptom Management Consultation Team

HPC Teams continued Housed with small admin office at Stronach Regional Cancer Centre Program Lead, Nurse Manager, admin assistant 5 Clinical Nurse Consultants –Work out in community –Consulting with providers and clients –Providing education

HPC Team Products Website Average new referrals 75 per month Average 300 patients on caseload at all times 90% of patients dying in setting of choice Average 40 ER Visits avoided per month Analysis of reasons for transfer to ER Analysis of reasons preference for place of death not met In home chart

HPC Teams Knowledge Transfer & Exchange Weekly case consultation meetings at local hospices Education sessions at long term care homes Cancer Care Ontario Symptom Guides training in collaboration with CCO Expected Death in the Home Protocol Symptom Relief Kit

Next Steps for HPC Teams – One time funded projects Comprehensive team based education for primary care and long term care providers Case based real time teaching and mentoring 24 hour response to avoid transfer to ER Research study on barriers to primary care involvement in HPC Research study on outcomes of mentoring

Long Term Goals for HPC Teams Physical location Add physicians and psychosocial expertise to teams Integrate physician teams Enhanced 24x 7 crisis response* (story) Expand teams to improve access – need 8 Clinical Nurse Consultants for full geographic coverage

Successes in other LHINs Champlain LHIN network recognized the need for a comprehensive integrated program for the Ottawa area. Undertook an extensive planning and engagement process over one year. –On line survey –Facilitated sessions – feedback

Outcomes in Champlain LHIN 1.Establishment of a regional HPC program accountable to the LHIN 2.A Leadership Council to over see the program 3.Formal agreements with service providers to oSupport the objectives of the program oIncorporate standards and competencies oEstablish performance indicators for evaluation and program planning

A HPC Program for CLHIN Strategy, planning and research Management of the HPC Program Access, Performance and Accountability Clinical Excellence Person and Family Advisory Group –Community Engagement Provider care and Development –Education and knowledge translation, capacity building Public reporting

Hospice Palliative Care for CLHIN CENTRAL LHIN BOARD HPC PROGRAM COUNCIL MANAGEMENT COMMITTEE PLANNING STRATEGY & RESEARCH ACCESS & PERFORMANCE COLLABORATIVE PERSON & FAMILY ADVISORY GROUP PROVIDER CARE & DEVELOPMENT GROUP CLINICAL EXCELLENCE COLLABORATIVE

Model for HPC in CLHIN HPC Program CLHIN HOSPICES HOSPITAL PCUs IN HOME CARE TEAMS LONG TERM CARE HOMES CCAC CANCER CLINICS PRIMARY CARE PALCARE NETWORK EXPERT TEAMS CONSUMERS CIRCLE OF ACCOUNTABILITY

The Future of Hospice Palliative Care for CLHIN Hospital Home Primary care Cancer centre Complete Care Plan Long term care Hospice Home Care Transport DNR EDITH Protocol CCAC HPC Teams A Good Death Bereavement care

LHIN Support The Central Hospice Palliative Care Network steering committee unanimously recommends that the Central LHIN dissolve the network and approve the formation of a Transition Strategy Team to lead a planning and engagement process to create a comprehensive Hospice Palliative Care Program for the LHIN

Thank you !