News coverage and personal experiences of lengthy wait times and closed emergency rooms have shaken Canadians’ confidence in their health system. There are also serious and chronic issues affecting the availability and accessibility of critical areas of care, including palliative care.
Death is a certainty for everyone. So, as the federal, provincial and territorial governments negotiate future health-care funding arrangements, they must make investing in palliative care a priority.
Palliative care is a holistic approach to addressing the needs of people with life-threatening or life-limiting conditions. It includes improved quality of life for patients and their families by addressing physical, psychological, social and spiritual needs.
An early introduction to palliative care, at the time of diagnosis, offers significant benefits. It can be provided while the patient is receiving other treatment and helps ease symptoms while supporting improved function amid life-limiting illnesses.
Palliative care can be provided in home, in long-term care facilities, residential hospices and hospitals. It can reduce the need for emergency department visits and unwanted intensive-care unit stays, while also enabling patients to remain at home for as long as possible.
Along with improved outcomes, palliative care also provides cost savings to the health system, particularly when offered early.
Despite these benefits, the necessary access in Canada is lacking. A recent report by the Canadian Institute for Health Information found some improvements, but there are ongoing “signs of poor-quality palliative care, including people not getting palliative care until just before they die, and people dying in hospital even when they have community supports.”
According to the Quality End-of-Life Care Coalition of Canada, “Canada lags behind its international counterparts in terms of access to quality end-of-life care” — despite having one of the most expensive health-care systems in the world.
Inequities in access, which exist particularly in rural communities and for Indigenous peoples, were exacerbated by the COVID-19 pandemic.
Meanwhile, the demand for palliative care is increasing. About 20 per cent of Canadians are 65 or older, according to the 2021 census. That’s up from 14.8 per cent of the total population in 2011. Meanwhile, the 85+ population went from 1.9 per cent of Canadians in 2011 to 2.3 per cent in 2021.
The percentage of older Canadians will continue to increase. At the same time, palliative care will still be needed for younger people facing life-limiting illnesses.
A long way to go meet commitments
Canada’s premiers accepted the federal government’s health-care funding proposal in February, including a $196.1-billion funding increase over the next decade. Part of the funding will be distributed through bilateral agreements to ensure that spending aligns with federal priorities.
One shared priority is “[h]elping Canadians age with dignity, closer to home, with access to home care or care in a safe long-term care facility.” Palliative care, especially community-based palliative care, will help fulfil this commitment.
But this is not a new idea. Governments committed to improving access to palliative care in the August 2017 common statement of principles on shared health priorities. Health Canada’s five-year action plan on palliative care also stresses the importance of improving palliative care and access to it, as well as improving data collection and research.
However, both levels of government have a long way to go to make good on these commitments. As agreements in principle are being made, the details of how funding will be spent will be laid out in bilateral agreements and three-year action plans. Accessibility to, training in and useful data about palliative care must be included.
Investing in palliative care
Simply adding funding will not be enough. There must be targeted investments in palliative care that align with each of the federal government’s four areas of priority.
The first priority is “expanding access to family health services, including in rural and remote areas.” This should include ensuring access to palliative care to all Canadians, regardless of their location, as a key component of family health services.
It should also include investments in education to help medical professionals, many of whom report feeling ill-prepared to provide such care. These investments could help get more “boots on the ground,” providing skills for health-care professionals.
This could include providing access to training for paramedics, who in some provinces are trained and equipped to assess and treat patients in their own homes. This may avoid many visits to emergency rooms.
Some programs train home-care and long-term care aides in palliative care skills. Some, but not all, family medicine and specialty residency programs contain mandatory rotations in palliative care.
These programs should be expanded as the new agreements are worked out between the federal and provincial and territorial governments.
The second priority is “supporting our health workers and reducing backlogs.” By prioritizing early referral and introduction of palliative care, demands on the health-care system can be reduced, lessening the strain on hospitals and health-care workers.
Most importantly, patients receive excellent care where and when they prefer it, leaving more room for living as well as possible within a limited life span.
Ensuring improved access to “quality mental health and substance use services” is the third priority area. Palliative care’s holistic approach involves attending to the psychological needs of patients and their families. However, many palliative care teams lack sufficient personnel, such as social workers and psychologists, to support these needs.
Supporting the mental health of both patients and their families when navigating life-limiting conditions and end-of-life situations is important. Accessible and expert bereavement programs support the mental health of all people who journey with a dying person, and foster healthy grieving.
Finally, modernizing health care with “standardized health data and digital tools” has also been made a priority. Data collection issues are a problem, including the need for clearer definitions and standards to assess and track access to palliative care.
Useful and accurate data lead to the best policy decisions and program development. It provides an opportunity to learn from other programs and from the experiences of patients and families.
Addressing the needs for improved palliative care during the upcoming funding negotiations will support Canadians as they encounter life-limiting conditions. As they age. It will also support the future of Canada’s health system, filling an unaddressed gap.
Ultimately, the health-care system needs more than an influx of cash. Prioritizing and investing in palliative care can support systemic changes that can benefit both Canadians and the system as a whole.