Palliative Care Strategic Aim
Palliative care aims to relieve suffering and focus on achieving comfort. Incumbent in the care is
respect for the persons nearing death and maximizing quality of life for the patient, family and loved ones.
With the overarching goal of Living Healthier at Home - Advancing integrated systems of care to help Central East LHIN residents live healthier at home, the Central East Local Health Integration Network (Central East LHIN) 2016-2019 Integrated Health Service Plan (IHSP 4) will guide, direct and inspire health system change.
Through the engagement process for the LHIN's 2016-2019 Integrated Health Service Plan, patients, caregivers and providers identified where improvements to the health care system are required as the system continues to support palliative patients to die at home by choice and spend 15,000 fewer days in hospital by increasing the number of people discharged home with support by 17% by 2019.
Palliative care, which includes end-of-life care, is holistic in nature and encompasses the following:
- addressing physical, psychological, social, spiritual and practical issues and associated expectations, needs, hopes and fears;
- preparing for and managing self-determined life closure and the dying process;
- coping with loss and grief during the illness and bereavement; and,
- promoting opportunities for meaningful and valuable experiences, and personal and spiritual growth.
Who is this Priority Population?
Living the highest quality of life until time of death remains the focus of the Central East LHIN’s Palliative Care aim. All those residents approaching death have the right to die with dignity, to have access to physical, psychological, bereavement, and spiritual care, and to be granted the respect and freedom of choice, consistent with other stages of life. Achieving the aim will mean ensuring timely access to quality palliative care is not only an ethical imperative but also a vital component of the health care system.
Choice for patients and families to receive care at home or in their communities and make informed choices about their care is a core element of palliative care. Engaging patients and family caregivers in Advanced Care Planning, involves proactive discussions with family, friends and health care providers. Currently, there is need for earlier contact with palliative care supports, broader use of palliative assessment tools and heightened cultural awareness.
Palliative care accounted for 2.2% of days spent in Ontario hospitals in 2013-14 (119,068 days) and the third largest proportion of acute care days behind heart failure and pneumonia. Across all LHINs, Central East LHIN hospitals had the largest proportion of acute days for palliative care. Similarly, in Central East LHIN hospitals, palliative care accounted for the largest percentage of acute care days at 22,789 or 5.0%. Currently, 70% of palliative patients are discharged from hospital with supports.
Building on Key Accomplishments
Integral to achieving the aim and ensuring that palliative patients continue to be supported to die at home by choice is the Central East Hospice Palliative Care Network. Established by the LHIN to over-see achievement of the Palliative strategic aim and provide guidance to the Central East LHIN on overall accomplishment of its IHSP, the Network developed a 3-year Palliative Care Strategic Plan that included five areas of focus:
- Palliative Care Community Teams;
- Hospice Palliative Care Education and Training;
- Integrated Hospice Palliative Care Hospital Programs;
- Integrated Hospice Palliative Care Programs in Long Term Care; and,
- Community Hospices as Hubs.
The following are a number of palliative care priority projects and investments which have contributed to and will continue to contribute to achieving our Palliative Care Aim:
- in partnership with the Central East Regional Cancer Program (CERCP) and with joint account-ability to the Central East LHIN and the CERCP, the lead champions both provincial and local strategies; and collaborates with local partners to improve palliative care across all patient populations, illness trajectories and health care settings
- support for service providers in home care agencies, long-term care homes, community support services, and primary care settings by providing access to Palliative Pain and Symptom Manage-ment Consultants (provide consultation, education, mentorship and linkages to palliative care resources across the continuum of care)
- program intended to strengthen community supports by enhancing the availability of NPs and the capacity to facilitate quality care to palliative clients in the home
Community Visiting Hospice Programs (Implemented)
- improve quality of life for individuals living with advanced illness, dying, and/or bereaved
- provide comfort, dignity and the best quality of life for individuals and families living with illness by offering holistic care
- a regional plan intended to increase access to specialized palliative care education and training opportunities across all settings, (including community and long-term care)
Palliative Care Community Teams (PCCT) (In development)
- interdisciplinary team-based models providing clinical and non-clinical community-based care to palliative and end-of-life patients
- partners include hospice services, hospital, CCAC, family health teams, community health centres, specialty care, and community service providers
Awareness Programs (In development)
- Central East LHIN has begun putting programs in place that will enhance awareness, expertise and service availability to support patients and families in need of palliative and end of life care
Residential Hospice (Future development)
- supporting the development of residential hospice services in the LHIN to support an appropriate model of end-of-life care that is not well developed in Central East
- opportunities will be supported and targeted for each planning cluster – Scarborough, Durham and North East
Advanced Care Planning (ACP) (Future development) - click HERE for current provincial resources
- ACP education and training to support clinicians, caregivers, PCCT etc.
- opportunities targeted towards FHTs, PCCT, and self-management programs currently underway
Integrated Hospice Palliative Care (HPC) Hospital Programs (Future development)
- supporting “Hospice Friendly Hospital” culture
- providing comprehensive palliative and end of life care for patients with advanced chronic conditions
- developing enhanced communication and collaboration across units, sites, acute care settings, community organizations
Integrated Hospice Palliative Care Programs in Long Term Care (Future development)
- supporting strong HPC philosophy and culture
- enhancing capacity of LTCHs to provide quality palliative end of life care
- integrating programming with behaviourally complex patient populations and specialized services supporting enhanced knowledge and awareness
Community Hospices as Hubs (Future development)
- publically visible profile for local hospice information and services
- centre of Excellence in HPC, grief and bereavement services
- common basket of core programs and services across local hospice settings, based on need
- 24/7 patient, family and caregiver volunteer support
- strong linkages and partnerships between local community and acute care settings
Ongoing achievement of the aim requires the coordinated actions of hospitals, primary and specialty care, the Central East CCAC and community organizations in partnership with patients and their families.
This strategic aim will also help support Ontario’s proposed model for hospice palliative care as identified in the provincial document, Advancing High Quality, High Value Palliative Care in Ontario: A Declaration of Partnership and Commitment to Action. In particular, it will encourage adults and children with life-threatening illnesses and/or advanced or chronic conditions to receive care that is proactive, holistic, person and family-focused, centered on quality of life and delivery of care by inter-professional teams in all care settings.
To track the system's ongoing progress against this Strategic Aim, please visit the Central East LHIN Performance page.
For more information on these accomplishments, please contact the LHIN at firstname.lastname@example.org or any LHIN-funded Health Service Provider.