How to make palliative care easier at home

This is part of a series from CBC's Information Morning where Halifax health-care consultant Mary Jane Hampton discusses her "health hacks" — ways to make your experience with the health-care system better.

Given the choice, most people would rather die at home than in a hospital bed. But the prospect of providing palliative care for a loved one can be daunting. What if something goes wrong that you can't handle?

There are supports to make it easier, and it starts by having a conversation about what the dying person wants.

"There are a lot of complicating issues that can get ahead of that personal agenda," health-care consultant Mary Jane Hampton told CBC's Information Morning. "Some of the concerns of the patients themselves are that symptoms might become unmanageable and it just may become an overwhelming experience. Family members can be very anxious that they may just get in over their heads. Things always happen overnight and on long weekends.

"So, when you're anxious about those things either as a patient or as a family member, that really can tip the balance between wanting the security of being in hospital, even though that's not really where you want to be."

How the program works

Nova Scotia has an emergency-care program through EHS that can help. Starting in 2015, all EHS ground ambulance paramedics received training to enable them to better care for people with palliative or comfort goals of care.

New practice guidelines were launched so paramedics could provide care without transporting the patient to the emergency department or hospital, if that's what they wish. These guidelines also give direction on symptom management, common in the late stages of many diseases, such as pain, breathlessness and nausea.

EHS also launched a  database where paramedics can receive specific information about the patient's condition.

"It's a good idea to register with this program, so paramedics can arrive with a clear understanding of the individualized-care plan and end-of-life comfort," Hampton said.

Help could include just providing an extra hand if someone has fallen out of bed.

"It's a fabulous program," said Hampton. "We talk about the need for health care to be patient-centred, and this is an example. If the patient has been clear that they don't want resuscitative services — they know their whole list of things that they do not want to happen to them — the paramedics ensure that comfort care is provided in the home.

"Assuming that there is a family member or someone around who is able to pick up on the care when they leave, they go and the patient's able to stay without the trauma of being transferred to hospital."

The paramedics are allowed to provide certain medications to manage symptoms, some of which are authorized specifically for palliative-care patients. They can also support the family through the uncertainty or panic of an unexpected turn of events, such as during those middle-of-the-night and long-weekend scenarios. So long as the person in care isn't taken to hospital, the visit is free.

Paramedics are 'uniquely' equipped to provide care

"When I'm asked how we can solve the problem of access to health-care services, one of the first solutions I point to is allowing different health-care professionals practise to their full scope," said Hampton.

"This program through EHS is a really good example of that. Paramedics don't always need to be about speed and sirens. They are uniquely able to bring care to your home, and help keep you there if that's what you want.

"You won't be schlepped off to hospital, which for many people is the last place they want to be. That should be respected."

For more information on registering for this program, visit here and here.

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