As we work toward a national policy on end-of-life care . . .

As compassionate Canadians, we are faced with some disturbing issues with the provision of end-of-life care. As compassionate Canadians, we like to assume that our health care is provided in an equitable, accessable, and timely fashion. And as compassionate Canadians, we want to ensure that this happens - but it is not.

In 2004, the Pan Canadian Gold Standard on Palliative Home Care was issued. It was reporting on an exhaustive look at the literature available on how hospice palliative care was being provided within the borders of Canada. It asked for input from all 10 provinces, three territories and all levels of government. Most responded with valuable input. In the final analysis, what stood out most in this accord, was the lack of consistency in care across the country and the inequitable access to services. We will discuss access to services in this post.

Equitable and universal access to healthcare services is one of the five pillars of the Canada Health Act. We believe that end-of-life care falls under this same mandate, obviously. Unfortunately, research reveals this to be one more area where the rural/urban divide is evident. We can think of many reasons for this, but none that actually make it right or fair. As discussed in an earlier blog post, 75% of all canadians have stated that they wish to die at home if given the opportunity, but fewer that 30% manage to do so. (More than 70% die in some type of institution - LTC facility, hospital, etc.) We acknowledge that it takes a tremendous amount of co-ordination to provide services to make this choice available, but it is being done, particularly in urban settings. Although we do not have ready access to statistics on the disparity between rural and urban outcomes in this regard, there is a strong indication that far fewer rural citizens have access to adequate supports to allow them this 'right'. The geographical logistics may be a burden to providing services. To this end, much time is spent travelling between clients rather than providing care. Also due simply to geography, it may be more difficult to access consistent pharmaceutical care for pain management and because more rural residents are self-employed, fewer have access to drug plans etc. The cost of providing pain management at home can often send a patient to hospital prematurely. And finally, are their voices being heard? It is often more difficult to draw together the voices of a few, especially as they are spread across a vast space.

Some questions to ponder - Does it cost more money to offer home care rurally? Is there a lack of political will on the part of provincial and municipal governments? Are hospitals vying for funds that should be going to community services? Does the shortage of nurses affect the availability of services? Because many rural citizens are self-employed (farming etc.) are they made ineligible for financial support? There are many questions to be answered. Stay posted!