At some time, in some way, we must all face the end-of-life. And most of us share a comomon hope that when death comes to us or to a loved one, it will be peaceful and free of pain. We hope to face death surrounded by those we love, feeling safe, comfortable and cared for.

Living Lessons (website)

More thoughts on policy . . .

Our last blog layed out the four key components of our suggested policy on end-of-life care. They are:

1. Universality
2. Care Coordination - a paid position
3. A broad range of basoc and advanced services
4. Assurance of EOL services, regardless of care setting.

Universality of care is understood as the provision of a full complement of social support and healthcare services to all persons who are faced with end of life, including those dying and their family.

Care Co-ordination

- will be discussed in a future blog, but it is understood that a necessary part of good palliative care is in the co-ordination of services. It is imperative that this role be fulfilled by an individual educated and skilled in the special demands and care considerations of palliative care. This must be a paid position.

Broad Range of Basic and Advanced Services - EOL is not focused on 'cure' but rather on comfort care. It requires a very broad range of services, including, but not limited to:

• good pain management
• spiritual care
• emotional care
• complementary and alternative care
• critical care (including extraordinary measures if requested at the time)
• financial aid
• information made available in a timely way, when needed
• home care equipment as needed
• bereavement services etc.

Care Setting simply refers to choice - the right to choose where one wants to receive the care required to die in a supportive, comfortable environment. This choice must include:

• the home
• hospice
• hospital
• long term care facility (which may indeed be home to many)

It is also important to note, that EOL may not take place in one setting only, but may rely on a variety of settings over a period of time. For instance, although the patient has chosen to die at home, the hospital may be necessary for short periods of time to stabilize a medical situation or correct a medication issue (or something other than that), with the full intention of moving the patient back to their home when all is manageable again. Or, a short time may be spent in respite care, allowing the primary caregiver to care for themselves momentarily. It is all about choice.

This all costs money. The final report of the Commission on the Future of Healthcare in Canada suggested $89.3 M be allocated to palliative care, annually to address these issues. We couldn't agree more.

More on resource allocation to come.