Reflections from Ontario

Ted and I have been travelling for the past week and have packed a lot into a short period of time!

We attended the PSNO PSW Conference 2014 in Markham, ON on October 21st. It was wonderful to meet 300+ personal support workers! One PSW, Derek, spoke about his work in hospice palliative care and highlighted some of the challenges. What stood out me was his emphasis on the value of team.

A big thank you to the PSW’s who stayed for the closing plenary. I know you were tired after attending for the entire day. I appreciate being able to tribute you and reflect on my learnings in HPC.

Next was the OCSA Annual Conference on October 22nd and 23rd.  Harry van Bommel, M.Ad.Ed., CTDP, spoke on Putting the ‘Care’ Back into Healthcare. Mr. van Bommel has developed resources to help people navigate and negotiate the system and these resources can be used and adapted to people’s local areas. He is as warm and as kind as when I met him in 1992 after the CHPCA conference in Winnipeg (my first HPC conference). I had the pleasure of meeting with Kathy Duncan from PalCare Network.  They have regular courses they offer in Newmarket, ON and an extensive library of palliative care books, manuals and journals available for loan. They also have a special conference coming up in March 2015 for PSW’s and community members that sounds fabulous, so if you’re in that area you may want to contact them to find out more information.

In the morning I met a beautiful woman named Jenny from Thunder Bay. She spoke about her work with such joy. Then she talked of the challenges and violence that has been happening in her community.  Within an hour she came to our table and told us about the shootings f the soldier in Ottawa.

As the day progressed and the story unfolded, my heart went out to those who mourn the death of Nathan. And along with other Canadians I share the collective sorrow that comes with witnessing violence born in mental illness.

Next up is Niagara Falls, Ottawa and then the OLTCA Fall Symposium in Markham which we’re really looking forward to.


Obama’s health care plan – Reimbursing physicians for discussing end of life treatment

How Obama’s health care might affect advance care planning discussions

As a hospice palliative care nurse, I was eager to hear about Obama’s health care plan regarding end of life issues. I was naively surprised to read media reports suggesting Obama was going to bring in “death panels” and “push the elderly to early death.” From my read, the bill allows physicians to be reimbursed for discussing end of life issues, and advanced directives with patients.

Stewart Florsheim is a board co-chair of Compassion & Choices of Northern California. This organization helps terminally ill people make end-of-life decisions, and he wrote:

“… Section 1233 simply ensures Medicare reimbursement for voluntary consultations about end-of-life treatment between patients and their medical practitioners every five years, or more often in the case of a life-threatening change. The consultations might include discussions about hospice, options for treatment (including pain management) and the importance of having an advance directive. The bill would help validate and support the work of palliative care doctors whose services are often subsidized by the rest of the hospital because they do not generate much revenue.”

See for the complete article.

Physicians are uniquely placed for discussions

Physicians are in a unique relationship, and have the opportunity to provide valuable information and support people to make informed decisions. Without advanced discussion, people may not have the blessings of discussing their illness, understanding possible outcomes of exacerbating their illness, and making informed decisions in advance of decline. Rather, the person may die “unexpectedly” (or so it seems) in emergency departments, specialty care units or acute care wards – all too often in crisis mode.

I hope that the National Hospice Palliative Care Organization and those working in hospice and palliative care in the United States will help Americans understand that discussing and preparating is part of excellent health care. This may also lead to discussions indicating that dying an ICU or other acute care settings, with all the bells and whistles, may not be best “end of life care!”

I also hope that Canada will follow Obama’s lead and reimburse our physicians for discussing end of life care, and advanced directives with our elderly and with others whose physical condition is unstable!