By Lethbridge Herald Opinon on March 11, 2020.
South’s palliative care system is cost-effective and good for patients, families
PALLIATIVE CARE PHYSICIAN
I am a palliative care physician in southern Alberta. We care for some of the most vulnerable patients and families in southwestern Alberta: those who are suffering from the end stages of serious illness, and those who are dying. Chances are good that you know someone who we have helped along their end-of-life journey.
We visit you in hospital, in hospice, in your home when you are too weak to leave, and at your bedside when you can no longer get up from bed. We drive to your home not only in Lethbridge, but in the surrounding towns like Taber, Raymond and Cardston, to Hutterite colonies, to Standoff, to farms and ranches. We explain your illness, your options, and what to expect in the coming days. We listen as you talk about your bucket list, your hopes and fears, and your suffering. We offer medications for your discomfort: your pain, struggles to breathe, nausea and confusion. We support your loved ones as they prepare for your death.
We are saddened at the need to write this, to warn you that the upcoming changes being imposed by the Minister of Health are going to decimate our ability to provide this end-of-life care to you in your home communities and in your homes. We ask for your help in telling Minister Shandro that we cannot look to save money off the backs of dying patients.
Southern Alberta covers a large geography, with many rural centres and many committed families who desire to support their loved ones at home in their home community – but they need the help of doctors in order to do so. This has led to the development of a unique approach to palliative care which came about under the guidance of now retired rural physician Dr. Rob Wedel. It was recognized that the usual payment for doctors, “fee for service,” which means that we are paid only for the time spent with patients, would not work for palliative care physicians to effectively support patients who are not able to travel to a clinic.
A clinical stipend (extra payment) was created to support palliative care physicians to provide value-added services that are not otherwise covered by Alberta Health, such as travelling for home visits, rural visits, and being available to answer home-care and EMS calls about our dying patients who are wishing to remain at home.
Without consultation with the Alberta Medical Association or our palliative care physician group, Minister Shandro has discontinued the South Zone Palliative Care clinical stipend as of April 1. Without this, the high-value services that the stipend was introduced in order to support will be lost. We choose this work because of our compassion for patients, and we are incredibly disheartened to think that we will not be able to provide adequate home visits, and will no longer be travelling to rural and remote communities at all. The consequences of this will be that patients will need to be admitted to hospitals and facilities earlier, which will actually increase the costs to the system while at the same time decreasing the quality of care and taking people out of their homes.
The hard-to-believe thing about this, is that it is well established that palliative care actually saves money. It is cheaper for the system to care for people at home than in a hospital or assisted-living facility, and it is cheaper to care for dying patients in a hospice than in a hospital. Patients who receive palliative care are less likely to receive expensive services in their final days and weeks, such as surgeries, CT scans and MRIs, and admission to ICU. Patients receiving palliative are also more likely to have a better quality of life, and caregivers have a more positive experience as well. Palliative care is a win-win: it’s cost effective, and it’s good for patients and families.
I think often of a young man in his 30s who I cared for in his home in Magrath, where he lived with his wife and three young children. He suffered from a terrible cancer, and his wish was to die at home. I was able to travel to his home several times as I worked along with his home-care team, to lessen his horrible pain and nausea so he could spend a bit more precious time with his boys. I remember the first time I pulled a tissue out of my bag to offer to him, and he joked “so that’s what palliative care doctors keep in their doctor bag!” I had the privilege to be in his home and help ease his way as he took his final breath with his wife at his side. It breaks my heart to imagine the possibility that I may not be able to do the same going forward.
If you or your loved ones have been touched by the palliative care service, please share your story with the Minister of Health and explain the need to continue this service. If you want us to be there when you are some day in need, please share your concerns. You can email Minister Shandro at email@example.com or share your thoughts with me at firstname.lastname@example.org.
Dionne Walsh is a palliative care physician who lives in Lethbridge.