History of Hospice Palliative Care in Quesnel
And it begins
In early 1985. Hospice Palliative Care began in Quesnel with a homecare nurse learning about Hospice Palliative Care and then asking the Internist and Director of Nursing at the time if he would help initiate this service for the community. It quickly became evident that team work was essential and an acute care nurse, as well as the hospital pharmacist joined the core team.
Initially, there was no budget allotment for Palliative Care. The acute care nurse added these new duties to the side of her desk. Later, the acute care nurse was allotted one day a month to conduct the duties of the Hospice Palliative Care Resource Nurse.
Vital to the provision of this Total Care Model were trained volunteers who could provide a ‘befriending’ service to those living with a life threatening illness. These volunteers were trained and supervised by a Coordinator of Volunteers.
Soon it became apparent that a formal organization was needed to take on responsibility and insurance needs for the trained volunteers.
By the fall of 1985, the Association had its inaugural meeting. Many of the public were our first board members and many of the executive board were from the health care system. Using Victoria Hospice’s constitution and bylaws as a model, we developed our own, and received our status as an official non-profit association in 1986. We could now officially take donations and begin fundraising.
BCHPCA became an umbrella association the year before we started our association.
Our first guest speaker, paid for by donations, was Nancy Reeves from Island Loss clinic who informed the public and the caregivers about healthy grieving and the effects of maladaptive grieving.
A psychologist/minster from one of our city churches conducted our first volunteer training program, another minister became our first volunteer Coordinator of Volunteers, and a psychologist from Mental Health program held our first grief support series.
The Anglican Church Diocese presented a TV series on Death and Dying that medical staff and caregivers watched and learned from. Members of the QDHPCA team took the week long Hospice Palliative Care education sessions on death and dying in Victoria.
We read the US and Canadian Hospice Palliative Care journals. Our local internist further developed his expertise by reading journals from the British Isles.
The hospital nurse took a 4th year university course offered out of University Of Victoria and attended a course in Victoria on pain management.
In short, everyone involved with, or interested in, everyone attended as many education sessions as possible to bettter help provide palliative care needs.
Hospice as a Place
As crucial as the need for education was, there was also a need for a special palliative room with a home-like environment. The Hospital Auxiliary provided the furnishings and though not yet officially designated a ‘Palliative Care” room, it was used for that purpose if not in use by a medical patient. “Out of Hours” visiting privileges were negotiated for family members.
The first end-of-life patient to use this room received specialized knowledge and care. She also taught the doctors, medical staff, and caregivers two valuable lessons.
A doctor, reluctant to ask the patient if she wanted her heart to be restarted if it stopped beating, was told, “Definitely not!” Thus, she was receptive to talk about her pending death. As well, her conversation with the Internist about the fact that the only person who offered to pray from her was a member of the housekeeping staff was unexpected!
Further education for this fledgling palliative care team!
The Core Team consisted of the Internist, a home care nurse, the acute care liaison nurse, the Coordinator of Volunteers, and the Spiritual Support Volunteer. They met every Thursday at noon to address issues involving patients and families on the palliative care program, and develop plans for the patient, family and the caregiver as appropriate. From the outset, this team included a spiritual person as we were very aware that as the physical body deteriorates the spiritual needs become greater.
The acute care nurse, the In-service Education Coordinator, and the Internist set up a Liaison Committee for Palliative Care. This committee consisted of a representative from Home and Community Care, the acute care liaison nurse, the pharmacist, the hospital physiotherapist, and the Association’s Coordinator of Volunteers and Spiritual Care Volunteer, and was chaired by the Internist.
The third Thursday of the month was for the liaison committee meetings where broader issues and concerns brought up by its members were addressed, recommendations identified, and appropriate action occurred. The policies, procedures, an protocols developed by this committee were built on research-based evidence. As new information became available, these policies and protocols were then revised.
Case reviews occurred every third month. A pain and symptom manual for use with patients the hospital, long-term care facility, and community was developed. The Palliative Care team in Quesnel was using protocols and had an emergency kit at the ready before many other hospitals, including Vancouver General, had theirs.
Quesnel was leading the field.
Patient conferences could be requested by any team member. These were held at home or in hospital, and included family and patient, the patient’s Doctor and the core team. Issues brought up at these conferences were transferred to the care plans, and plans to address the issues were developed. On rare occasions, a second case conference was needed. It became very evident that when the family, the patient and the caregivers were ‘on the same page’, things went so much smoother.
Hospice, not Hospital
As we grew and got better at pain and symptom management we realized that an acute care bed was not the place to have Palliative Care patients. There was the noise of the intercom and the call bell system, along with the busy activity that goes with an acute care ward.
An evaluation of the existing service was performed with patients, family members, staff, and the public included in the process. The Palliative Care Board called a strategic planning meeting, inviting the public to participate in the discussion; consensus determined that a hospice house would be the answer.
It soon became apparent that this project would involve more than purchasing and renovating an existing house somewhere close to GR Baker Hospital. Thus began 15 years of fundraising, sustained and supported by the entire community.
The major donors were Diana McColl and estate, Quesnel Rotary Club, Tolko, Arion Gabriel, Canada Safeway, and Hydrecs.
In June of 2005, Northern Health offered to include three palliative care beds as part of the addition to Dunrovin Park Lodge. QDHPCA negotiated including a separate hospice Unit with an additional three respite beds with Northern Health agreeing to cover all operating costs for the Unit.
The Association pledged to commit $500,000 to the capital cost and to provide all furnishings, fittings, and fixtures, and, in August of 2009, the community joined the Association in celebrating the opening of Quesnel’s Hospice Palliative Care Unit at Dunrovin Park Lodge. In 2009 an anonymous donor made it possible to add a deck to the back of the Hospice Palliative Care Unit for the use of the patients and families which was incorporated into the completion of the garden and fence.
The Association remains active with fundraising in order to meet on-going needs for equipment and furnishing in the Hospice, with Home and Community Care, and in the community. We are committed to providing as much education and training as we can fund for physicians and medical staff, for our Contract workers, and for our Volunteers.
We also focus on public awareness and education, working toward a time when all members of the community know what palliative care is and why Hospice is an option, and understand what services the Association offers and how to access those services. We advocate for equitable access to palliative care for all, encouraging those in positions of influence to see the value of, and need for, both medical palliative care and the Associations who support that care.
From the Association’s perspective, there has, in recent years, been a clear delineation between the two components of quality palliative care: the medical piece, financed, managed, and controlled by the Health Authorities and the Province of BC; and the support piece, championed and sustained by volunteer associations such as Quesnel & District Hospice Palliative Care Association. It is important to remember that the genesis of Hospice Palliative Care in Quesnel was a meeting of the minds between those 2 groups. It is also important to remember that both groups have always had the same goal in mind – the best end-of-life care for the dying, at home if possible; in Hospice if not.
We are supported by the standards as developed by the Canadian Hospice Palliative Care Association. We look to them for our guidance. The BC Hospice Palliative Care Society has produced guidelines for training volunteers. The association has an active board with an Executive that conducts the business of the society. We are confident that Hospice Palliative Care will continue to be a part of our health care system in Quesnel.
QDHPCA Membership Form