The David Thompson Health Advisory Council hosted a recent virtual discussion on palliative care in the region.
Held Jan. 13, 2022, the hour-long discussion outlined the differences between palliative and end-of-life care and what services are available to patients in the central Alberta region.
“Palliative care aims to improve the quality of life of patients and families facing the challenges associated with life-limiting illness through the prevention and relief of suffering,” stated the definition in the presentation slides.
According to palliative care specialist Mary Sabbe, who was presenting, early intervention in palliative care is key to “helping individuals to live fully” and relieve suffering after diagnosis of a life-limiting illness.
The goals of palliative care are to help patients and their families deal with “physical, psychological, social, spiritual and practical issues” surrounding the dying process.
“Palliative care is available to every Albertan,” said Sabbe, though she did note there were some challenges.
Challenges include limited access in rural communities and stigma and misconception of what palliative care is.
To help solve the problem with limited access, Alberta Health Services (AHS) has created a palliative care team which works throughout the region.
The team is made up of 16 specialized palliative care registered nurses, one nurse practitioner, one continuing care counsellor, one professional practise lead, and six physicians with an “interest and knowledge” of palliative care.
Health professionals can access the palliative care team through a 24-hour on-call service for patient referrals.
In addition to the team which works throughout the central zone, there are also 20 hospice spaces in the region: 16 provided by Red Deer Hospice, two spaces located in olds, one in Rocky Mountain House and one in Stettler.
Other communities throughout the region provide hospice services but do not have dedicated space, according to the presentation.
Another team helping provide service is the province’s Emergency Medical Service’s (EMS) department, through their Assess, Treat, Refer (ATR) program.
The ATR program allows paramedics to assess and treat palliative care patients in their homes, provided “emergency treatment matches the care plan,” said Sabbe.
“To initiate the algorithm, the patient must be palliative, they must wish to remain at home, and the decision must be consistent with the goals of care,” said Sabbe.
“This can be initiated by clinicians only. There is no lights or sirens. Responders are not calling attention to the home.”
To further support rural palliative care in the central zone is in-home funding which can be accessed by caregivers.
This funding can be used for unmet care needs of the patient, provided the patient is eligible for Home Care Services, existing resources are exhausted, and the patient has a desire to stay at home and needs more care to do so.
The funding will offer up to $10,000 per client, according to Sabbe, and can be used for personal and respite care.
“A lot of rural communities do not have contract providers,” said Sabbe.
“This funding allows them to hire their neighbours.”
Sabbe did note that any medical professionals hired to provide the service must follow their licence while providing care.
A final topic discussed during the hour long presentation had to do with advanced care planning, or more specifically the different documentation surrounding it.
While the average person would know what a will is, the document which describes what happens to one’s estate on one’s passing, fewer know about personal directives.
“Think about your wishes,” said Sabbe.
“Learn about your own health, and choose someone to make decisions who will communicate your wishes and values.”
A personal directive is a legal document which appoints someone to make healthcare related decisions for you when you are unable.
“There is no standard form,” said Sabbe.
The only requirements for a personal directive are it needs to be in writing, it needs to be signed, and it needs to be witnessed by someone other than the person listed as your agent.
Spouses, or the agent’s spouses or partners, cannot be used as witnesses.
Another document which discusses patient wishes is the Goals of Care Designation (GCD, which a patient needs to discuss with their doctor.
The GCD, or Green Sleeve, is a medical order signed by one’s physician which determines the level of resuscitation a patient is to receive.
The order proceeds from full resuscitation — all efforts to revive someone including chest compressions — all the way down to just providing basic pain management and symptom control.
“A personal directive does not replace a GCD,” said Sabbe.
In the order of priority, the GCD form, as discussed with one’s doctor, would be the ultimate decider in patient care, followed by the agent appointed in the personal directive, though it should be noted that neither option overrules a patient changing their mind and providing consent for full treatment, if they are capable.
If there is no GCD in place, a patient is automatically assumed to be full resuscitation.
For more information, or to access palliative care services in the central zone, contact your family physician, home care nurse or the continuing Continuing Care Access Centre at 1-855-371-4122.