March 26, 2008

Leading the Integration of Compassion

Winnipeg's Palliative Care Program

It's not an easy subject.

It's not an easy job.

But in the Winnipeg Regional Health Authority, a team of health care professionals strive each day to improve the availability of and access to quality palliative care in Winnipeg.

Winnipeg has a long, rich history of quality palliative care. St. Boniface General Hospital was home to the first palliative care program in Canada in 1974. Since then, services throughout Winnipeg have been integrated with a goal of achieving equitable access to palliative care within each area of the city. But it's not a simple objective; in fact, many other cities in Canada have not developed a model that works as well for individuals requiring palliative care as Winnipeg's program does.

Palliative care programs work to alleviate pain and other symptoms for individuals with illnesses which are likely to take their lives in a relatively short period of time. The Winnipeg health region's Palliative Care Program is available to persons of any age with any life-limiting illness and strives to alleviate the stresses associated with this phase of life for both the patient and their family. Inpatient palliative care units are housed in three health care facilities in Winnipeg: St. Boniface General Hospital, Riverview Health Centre, and the Grace Hospice. The program also partners with Jocelyn House to provide hospice care through their facility.

"Although the inpatient units tend to be what people recognize as palliative care service, the bulk of our program activity is in the community. Inpatient unit beds are generally utilized for short term admission patients who are experiencing acute symptom issues. Once those issues have been resolved, we work with patients and families to develop a discharge plan
whenever possible. The most innovative part of our program is the integration across care settings," said Dr. Mike Harlos, Medical Director for the Winnipeg Regional Health Authority Palliative Care Program.

This is a notable strength which the Winnipeg program has over many other palliative care programs in Canada. The Winnipeg program spans the entire continuum of care: acute, long-term, community, and palliative.

In many other regions, palliative care services tend to be specific to a care setting, such as a facility or a community area, and the intake process must start again when the care setting changes. In addition, community based programs in some cities are independent homecare programs with services that differ significantly based on the neighbourhood they are within. In contrast, the Winnipeg health region's Palliative Care Program works on integrating all aspects of care, regardless of care setting.

"No matter where you are in our system or at home, or what transfers you make within palliative care, your Palliative Care Program coordinator always knows where you are and can get services to you - they are like the quarterbacks for your care," said Dr. Harlos.

Initially, all Palliative Care Program patient referrals go through one Central Intake office. Central Intake then forwards each referral to a Palliative Care Program coordinator in the area of Winnipeg most appropriate for that individual. Coordinators review the referral information and needs of each patient. This includes listening to any concerns they or their family have, and pulling together equipment and human resources to help meet physical, emotional and spiritual needs of the patient and family members. Coordinators work closely with Home Care, the inpatient palliative care units, CancerCare Manitoba, Hospice & Palliative Care Manitoba, and others to provide expert end-of-life care to individuals in a variety of settings including home, personal care home, hospice, outpatient clinics, acute care inpatient units, and intensive care units.

With over 1300 patient referrals coming through Central Intake each year, one of the main challenges for coordinators is prioritizing palliative care beds based on symptom management, psychosocial and spiritual needs and the ability of the patient and family to get their needs met in their current care setting. Anticipating care needs of each individual so the team can stay a step ahead of things which may prevent the patient from meeting their care goals can also be challenging.

"Our program is unique in Canada, but it is the commitment of the staff that really makes us what we are," said Lori Embleton, WRHA Palliative Care Program Director.

Embleton added that the team includes a variety of professionals working in the care settings. In the community, six Palliative Care Program coordinators work closely with more than 35 community Palliative Care Program nurses who are available to see patients and families in their homes and refer information back to coordinators and/or physicians if any adjustments are needed in a patient's care. Patients and families have access to the community nurses 24 hours a day, through a pager number. Other members of the community team include: a service coordinator who works to ensure supplies and services for each patient are in place in the community; clinical nurse specialists, available in the Region to see patients on a consultative basis and provide support for program and educational initiatives; attending palliative care physicians who provide care on inpatient units and support physicians throughout the Region who are involved in caring for palliative patients; and the community psychosocial support specialist who plays a vital role in providing support to individuals and families, and assisting staff in providing ongoing support to their patients and each other. The community program works closely with inpatient unit health care teams which include nurses, social workers, spiritual care, pharmacists, physiotherapists, occupational therapists and other allied health professionals.

Although the work is challenging and sometimes difficult, it is also immensely rewarding. Members of the team are privileged to be able to make a difference in people's lives at a time when they need help. This is what often draws people to this area of care and keeps them engaged for long periods of time.

"If we can do one thing for palliative care across Canada it will be to raise the bar on people's expectations for death and dying," said Dr. Harlos, "The lifetime prevalence of death is 100 per cent. It may be hard to talk about but it is a self-evident truth and an important issue. If death is going to happen, let's raise communication, attentiveness and responsiveness for people when it is happening."

- Kathryn McBurney


For more health and wellness news, pick up the Spring 2008 edition of Aspire, now available at selected WRHA offices and facilities.

Aspire is also available for download here:

Aspire - Spring 2008

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