Death is not an option. It is an experience each of us will face one day. How we, or our loved ones, are cared for during that experience has taken a significant turn for the worse as local administrators once again reduce service levels while trying to convince us that adequate care is still available. Nurses and physicians in both hospital and home care settings will continue to give care to the dying as they can while caring for many other clients at the same time, but they will have to do that without support from a hospice palliative care coordinator.
The volunteers that are remaining will continue to sit at the beside of the dying, but they will do that without adequate assessment of the family and client needs, and with less training and support, as the Coordinator of Volunteers has been forced to also take on the Friendly Visitor program in the minimal 12 hours per week she has been allotted for these two jobs .
The stand of Interior Health in this rural area of the West Kootenays is falling far short of the BC Ministry of Health Services Provincial Framework on End of Life Care (found at http://www.health.gov.bc.ca/hcc/endoflife.html). That framework, covering all British Columbians, mandates well-planned and well-coordinated interprofessional care delivered by competent and well-trained providers, with expert back-up support from specialists, and psychosocial support for the staff who spend time providing palliative care. With the loss of the palliative care social worker and the previous clinical palliative care and bereavement nurses, as well as the underutilization of a community doctor trained in palliative complications, staff in hospital, residential and community venues are left without on-site specialist help and care coordination in our community.
Consider the capability we have previously had to provide excellence in palliative care. Using 2006 as an example, there was a nurse trained and certified as a palliative care specialist who worked with the palliative physician, the social work department, and nursing staff with a focus on the complex cases. There was a second trained nurse who provided bereavement support to families and individuals. As well, support was given to front line nursing staff and professional caregivers as they also faced end of life care issues and often lacked the emotional support that would enable them to care for the next hospice patient/client. Psychosocial care, no less important than symptom control, addressed the emotional and psychological experience of loss and death facing clients, patients families and care providers, helping them express their thoughts, fears, feelings and concerns relating to a terminal diagnosis. It also included practical care by providing assistance with financial concerns, housing aids, or helping to mobilize family resources . Over that year more than 300 families and individuals were cared for, staff were sustained in their day-by-day care, and volunteers were given specific and on-going training which enabled them to offer 1200 hours of service day and night to the dying. Previous Hospice Coordinators and the recent palliative social worker carried on that same vital work.
It is not sufficient or conscionable to think that adequate palliative care services can be given by busy front-line staff who must also care for patients of all types and by one part-time volunteer coordinator. Palliative care is a speciality and requires currency in best practice, coordination, consultation, continuity of care and vision to ‘raise the bar’ to the level of excellence it should be. Our rural community needs and deserves to have the palliative service mandated by our own provincial Ministry of Health, at the expanded level that is granted to many communities in other parts of our Health Authority.
Join us at the Candlelight Vigil outside of Kootenay Boundary Regional Hospital on Wednesday, June 9th at 8PM. The candles will symbolize mourning for the services we have lost but will also signify the light that needs to be shed on our need.
Previous Hospice Palliative Care Coordinators: