1. 1 The Evolution of Hospice Palliative Care Policy and Practice in Ontario, Canada

2. 2 Introduction  Ontario: Demography & Geography  Urban vs. Rural South vs. North  Local Health Integration Networks (LHINs) Figure 1: Ontario Local Health Integration Network Boundaries. Map available at: http://www.lhins.on.ca

3. 3 Methods  Review of academic & grey literatures  Preliminary timelines  Review of timelines by key informants (n=8)  Follow-up semi-structured interviews with key informants  Thematic content analysis of interview data (Aronson, 1994) & revision of timelines by research team

4. 4  Chronological list of provincial hospice palliative care (HPC) key milestones from 1979 to 2009 ◦ 1. Late1970s & 1980s: The Foundational Years ◦ 2. 1990s: Increased Provincial Government Involvement ◦ 3. 2000-2009: Union of Stakeholders  Influence of federal government  Role of associations and advocates  Rural lag: “Rural care is like a big black hole.” Results

5. 5  Late 1970s and 1980s  Origin of HPC in Canada  1979: 1st community-based hospice  Provincial associations established 1. The Foundational Years

6. 6 2. ON Gov’t Takes Notice of HPC  1990s: Few HPC milestones  Education funding provided by Ministry of Health  Health Care Services Restructuring: Shift to community care  Rural health service delivery challenges acknowledged  National senate committee report

7. 7 3. Stakeholders Unite for HPC  2000-2009  National report: Quality End of Life Care: The Right of Every Canadian; HPC funds through 2003 Canadian Federal Health Accord  End-of-Life Care Strategy enacted in 2005; Networks established  Rural education initiatives through Pallium (2004-2006) & federal support for residential hospices  Two provincial associations host first collaborative HPC conference in 2009  HPC Provincial Think Tank in 2009 & stakeholder group forms

8. 8  HPC in Ontario has evolved over the last 30 years and continues to move forward  Rural areas continue to lag behind but there is movement taking place  Increased efforts on integration and coordination of care  HPC Networks & unity of stakeholders holds potential Conclusion