Dorothy sits across from me at Calhoun?s on West Broadway in Vancouver BC. Her eyes are bright and relentlessly honest. Although slight creases in her face suggest her age, she seems light. Her bouyancy suprises me when she shares anecdotes from working thirty years on the front lines of palliative home care.
?It is a privilege to connect with so many people and their families. Everyone has their own unique story and family dynamic. It is crucial to have the time to build connections with palliative home care patients. I don?t understand why we [nurses] are increasingly pressured to rush. Things have changed a lot over the past few years.? says Dorothy. ?I hope that you can back-up my anecdotes with research?.
?I promise that I won?t write anything until I find research to back up what you are saying?. I reply.
The Research
The Canadian Centre for Policy Alternatives has been following the ?steep decline in home and community care services? since 2001 and their numbers indicate that home and community care services have declined by 14% in the past decade.
The CCPA studies verify what Dorothy has seen and what I have written in my previous posts, Palliative in BC: a daughter's view of the health care system and The truth about dying in Vancouver. Although the majority of my struggle was the despair of losing my mother, it was also the devastation of losing faith in the ability of our province and city to care for our most vulnerable.
The CCPA 2012 report titled, Caring for BC?s Aging Population, explains how ?a decade of underfunding and restructuring has led to a home and community care system that is fragmented, confusing to navigate, and unable to meet seniors? needs?. These studies are aimed to bring clarity to what had become ?a numbers game, with the provincial government claiming it had increased the availability of services despite evidence of a growing crisis in access to care in communities around the province, particularly as a result of the closure of residential care beds.?
Time is the greatest commodity
According to Dorothy, the patients that are sent home from the hospital are sicker than she has ever seen in her thirty years of home care service. ?I am not sure why there are people being sent home with such extreme health conditions.?
She recalls a time when she delivered medication to little old ladies and had enough time to alleviate their isolation with a cup of tea. ?Their eyes would sparkle and light up when I delivered their medication, because they were almost always alone. They would say that our visit was a highlight of their week.? Dorothy recalls as her eyes smile at the memory.
The brightness in Dorothy fades as she returns to the present. ?Now, the medication is just dropped off by a delivery service through the pharmacy.?I have to justify the time I spend with patients by listing specific tasks that are completed. We are not supposed to spend time getting to know our patients,? she says.
According to Dorothy, there are many important reasons to have more time with patients:
1. When nurses have more time with patients, they can achieve trust, that is not built in quick visits.
2. The trust and connection is essential to understanding the condition of each patient.
3. When nurses have more time, they can answer questions that emerge naturally through conversation
4. A rushed visit prevents nurses from providing care that is aligned with the ideologies of nursing school.
Why would Vancouver Coastal Health reduce time spent with home care patients when the aging population is rapidly increasing and isolation puts patients at risk? A task-based model of care turns patients into objects, rather than individual human beings. According to the 2011 Seniors Vulnerability Report by the United Way, ?projections indicate that by 2036 Canada?s population of seniors will grow from 14 to 25 percent of the country?s total population. Close to 1 in 4 people will qualify as a senior.?
Improved home care would reduce wait times for all patients in hospitals.
It doesn?t take expensive research for us to figure out that insufficient home care results in palliative patients returning to hospitals that don?t have room for them. However, it is helpful that solid research can puncture the denial that seems to plague Vancouver Coastal Health and anyone who claims that we are not facing a growing crisis.
In Caring for BC?s Aging Population, the CCPA spells out the collective awareness amongst experts, ?Among health providers and within governments, there is growing recognition that a comprehensive and well-coordinated home and community care system can significantly alleviate pressure in the most expensive part of the health system?hospitals?by reducing wait times for both emergency and surgical services.? This recognition is reinforced by national reports by the Wait Times Alliance on wait times for hospital services across Canada.
Improved home care saves money that could be put back into healthcare.
When my dying mother was sent home from the hospital, I was terrified and I was told that a palliative hospital bed would cost $3,000 per day in the US. The reason that I survived my mother's discharge was due to the discovery of innovative tools like Tyze, in addition to a lot of creative problem-solving and trouble shooting.
Once we were all set-up and organized, it occurred to me that my voluntary labour was saving taxpayers an enormous amount of money. Even if a palliative hospital bed cost $2,000 dollars a day, there is a huge saving: thousands of dollars spent daily in hospital versus approximately $200 spent daily on home care.
According to my calculations, my role as a caregiver saved tax-payers between $300,000 to $400,000. When this savings is calculated into the bigger picture, it seems illogical and inhumane to limit access to basic services for home care patients.?
"Why is it so hard to access a palliative home care doctor?" I wondered.
?The palliative home care doctors are excellent?, explains Dorothy.
?However, there are only two of them for the entire city of Vancouver. They are often back-logged with home care requests? she says.
The CCPA also echoes this reality of limited access to services, as it explains how ?restructuring in home and community care?such as changes to policies that govern when seniors get access to what types of care?has undermined the vital prevention role these services can play. In both residential care and home support, eligibility criteria have become increasingly restrictive, to the point that seniors often have to wait until they are in crisis and admitted to hospital in order to get the community services they require.?
There is a deep denial surrounding the status of Vancouver's palliative care system. As the need increases, the services are stretching to the point of breaking. Do you want to subscribe to this expensive plague of denial and turn the other way? Or do you believe that a lifetime of paying taxes should result in proper end-of-life care? Death is the one thing that we all have in common. It is our responsibility to care about our dying citizens. ?
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