Better home support for dying patients in Vancouver would improve hospital wait times

Dorothy sits across from me at Calhoun’s on West Broadway in Vancouver, BC. Her eyes are bright and relentlessly honest. Although slight creases in her face suggest her age, she seems light. Her bouyancy suprises me when she shares anecdotes from working thirty years on the front lines of palliative home care.

“It is a privilege to connect with so many people and their families. Everyone has their own unique story and family dynamic. It is crucial to have the time to build connections with palliative home care patients. I don’t understand why we [nurses] are increasingly pressured to rush. Things have changed a lot over the past few years,” says Dorothy. “I hope that you can back-up my anecdotes with research.”

“I promise that I won’t write anything until I find research to back up what you are saying,” I reply.

The research

The Canadian Centre for Policy Alternatives has been following the “steep decline in home and community care services” since 2001 and their numbers indicate that home and community care services have declined by 14 per cent in the past decade.

The CCPA studies verify what Dorothy has seen and what I have written in my previous posts, Palliative in BC: a daughter's view of the health care system and The truth about dying in Vancouver. Although the majority of my struggle was the despair of losing my mother, it was also the devastation of losing faith in the ability of our province and city to care for our most vulnerable.

The CCPA 2012 report titled, Caring for BC’s Aging Population, explains how “a decade of underfunding and restructuring has led to a home and community care system that is fragmented, confusing to navigate, and unable to meet seniors’ needs”. These studies are aimed to bring clarity to what had become “a numbers game, with the provincial government claiming it had increased the availability of services despite evidence of a growing crisis in access to care in communities around the province, particularly as a result of the closure of residential care beds”.

Time is the greatest commodity

According to Dorothy, the patients that are sent home from the hospital are sicker than she has ever seen in her 30 years of home care service. “I am not sure why there are people being sent home with such extreme health conditions.”

She recalls a time when she delivered medication to little old ladies and had enough time to alleviate their isolation with a cup of tea. “Their eyes would sparkle and light up when I delivered their medication, because they were almost always alone. They would say that our visit was a highlight of their week,” Dorothy recalls as her eyes smile at the memory.

The brightness in Dorothy fades as she returns to the present. “Now, the medication is just dropped off by a delivery service through the pharmacy. I have to justify the time I spend with patients by listing specific tasks that are completed. We are not supposed to spend time getting to know our patients,” she says.

According to Dorothy, there are many important reasons to have more time with home care patients:

1. When nurses have more time with patients, they can achieve trust, that is not built in quick visits.

2. The trust and connection is essential to understanding the condition of each patient.

3. When nurses have more time, they can answer questions that emerge naturally through conversation.

4. A rushed visit prevents nurses from providing care that is aligned with the ideologies of nursing school.

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