Quesnel & District Hospice & Palliative Care Association

ADVOCACY PLAN

1. Direct Care Hours per Resident Day/Increasing Access to Hospice Care

• Arrange zoom meeting with Daryl Petsul, GR Baker Hospital Administrator, and Pat Tressiera, Manager, Dunrovin to discuss what the average direct care hours per resident day are for the Quesnel Hospice, Dunrovin, and palliative care beds at GR Baker Hospital. 

• Ask about current recruitment/staffing challenges.

• Confirm who the current lead for Palliative Care is.

• Discuss the QDHPCA developing a presentation and resource materials for doctors to on discussing/referring patients for hospice/palliative care.

The Ministry of Health 2019/20 – 2021/22 Service Plan
Objective 1.2: Improved health outcomes and reduced hospitalizations for seniors through effective community services. 
A Key Strategy:  Improve range of supports to people in residential care homes to ensure they receive dignified and quality care with a focus on achieving an average of 3.36 direct care hours per resident day across each health authority by 2020/21 and working with care providers to embed person-centered respect and compassion in all service delivery

Objective 2.3: Continued improvement of other key primary and community care services
A Key Strategy: Continue to increase access to both community-based hospice care and the number of hospice spaces in the province in line with regional population health needs.

B          Contact the BC Hospice Palliative Care Association regarding their Advocacy efforts

• Get a list of issues the BCHPCA is advocating for provincially and federally, and develop a plan for supporting that advocacy locally (could be with local MLA & MP, City of Quesnel, Cariboo Regional District, or others)
   

C          Promote education of current and developing concepts of palliative care strategies to professionals and caregivers.  (From the QDHPCA Goals)

• This information reaches physicians, nurses, physiotherapists, Home Makers and Home Support workers. This information can be shared with other Palliative Care caregivers outside the local community, (so as to) enhancing the knowledge level of care modalities. 

• Discuss the development and presentation of the forms and costs for hospice/palliative with the GR Baker Palliative Care lead, so local doctors.

 

D         Meet with our MLA and MP to advocate for Hospice and Palliative Care

• Issues to be determined after hearing from GR Baker Hospital and Dunrovin, and the BCHPCA, as well as other Hospice and Palliative Care Associations.

• Possible areas of discussion include increasing Federal Health transfer payments to BC, additional mental health supports for seniors

 

 

PROVINCIAL SERVICE PLAN/HOSPICE/PALLIATIVE CARE INFORMATION
January 27, 2021
BC Ministry of Health Annual Report for 2019/2020, https://www.bcbudget.gov.bc.ca/Annual_Reports/2019_2020/pdf/ministry/hlth.pdf
Line items or service plan performance measures found to relate to Hospice/Palliative Care:
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Objective 1.2:Improved health outcomes and reduced hospitalizations for seniors through effective community services
Key Strategies:
Continue to focus on improving integrated team-based care for seniors with complex medical conditions and/or frailty by implementing specialized services. Health authorities will ensure improved access, quality and coordination of care across services through interdisciplinary teams to better meet the needs of clients and their families. Specialized service for seniors with complex medical conditions and/or frailty will integrate and coordinate all services for this patient population including home support, community-based professional services, community caregiver supports, palliative care, and assisted living.
Maintain ongoing engagement of seniors centres, community centres, cultural organizations and multi-service non-profit societies in providing health and wellness, cultural, educational and other services to support seniors in community
Improve range of supports to people in residential care homes to ensure they receive dignified and quality care with a focus on achieving an average of 3.36 direct care hours per resident day across each health authority by 2020/21, and working with care providers to embed person-centred respect and compassion in all service delivery.•Continue work to improve accessibility, responsiveness, and quality of community-based palliative care, and continue to provide end-of-lifecare services including hospice and home-based palliative care to support those at the end of life with greater choice and access
With the guidance of B.C.’s Seniors Advocate, continue to improve access to home and community care, and focus on increased service levels to better address the needs of seniors.
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Objective 2.3: Continued improvement of other key primary and community care services
Key Strategies:
Continue to increase access to both community-based hospice care and the number of hospice spaces in the province in line with regional population health needs.•Improve and strengthen long-term care services to ensure seniors receive dignified and quality care
NOTE: There are not specific performance measures for the hospice and palliative care performance measures.
Per Diems
https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/end-of-life-care
Is there a cost for end-of-life care and palliative care services?
There may be a cost for end-of-life care or palliative care services, depending on the type of services you require.
There is no cost for community nursing services or community rehabilitation services if you are receiving care at home. Some medications and palliative supplies and equipment are available free of charge for eligible patients through B.C. Palliative Care Benefits. In addition, there is no cost for home support services if you are enrolled with B.C. Palliative Care Benefits. For more information, please see the “B.C. Palliative Care Benefits” section, below.
If you require publicly subsidized hospice  care, you will pay a fixed daily rate of $39.61 per day. For more information on costs or eligibility for short-stay services (which includes hospice care), please see:
•    Short-Stay Services
If payment of the fixed daily rate would cause you or your family serious financial hardship, or mean that you (or your spouse, if applicable) would be unable to maintain the family home or unit, you may be eligible for a reduced rate.
For more information on eligibility and how to apply for a temporary reduction of the daily rate, please see:
•    Temporary Reduction of Your Client Rate
B.C. Palliative Care Benefits
B.C. Palliative Care Benefits supports B.C. residents of any age who have reached the end stage of a life-threatening illness and want to receive medically-appropriate palliative care at home. ‘Home’ is wherever the person is living, whether in their own home, with family or friends, in an assisted living residence or in a hospice that is not a licensed  community care facility covered under PharmaCare Plan B.
The intent of B.C. Palliative Care Benefits is to allow patients to receive palliative care at home rather than be admitted to hospital. The benefits give palliative patients access to the same drug benefits they would receive in hospital, and access to some medical supplies and equipment from their health authority.
The benefits include full coverage of approved medications, equipment and supplies (upon referral to and assessment by the local health authority).
For more information on B.C. Palliative Care Benefits, including eligibility requirements, a patient information sheet and list of approved medications, go to:
•    BC Palliative Care Benefits
Palliative Care Benefits (Plan P) - Information for Prescribers
BC Palliative Care Benefits are available to B.C. residents of any age who have reached the end stage of a life-threatening disease or illness and who wish to receive palliative care at home, meaning wherever the person is living. This can be in their own home, with family or friends, in a supportive/assisted living residence, or in a hospice unit at a residential care facility (e.g., a community hospice bed that is not covered under PharmaCare’s Residential Care Plan (Plan B)).
Eligible patients receive
•    Coverage of medications used in palliative care through the PharmaCare BC Palliative Care Drug Plan (Plan P), and
•    Medical supplies and equipment through the local health authority.
•    BC Palliative Care Benefits Registration Form (HLTH 349) (PDF, 389KB)
•    Prescriber Guide (PDF, 1.0MB)
•    Palliative Care Drug Plan (Plan P) Formulary
•    Patient Information Sheet (PDF, 475KB)

Long Term Care COVID-19 Response Review:
https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf
5.2 Short Term Recommendations
Workforce
1.    Single site order has been an important factor in mitigating spread. While it remains in place, the ministry should consider increasing FTE allocation above the budgeted baseline to help operators manage absences such as sick time and vacation without having to use overtime or causal staff.
• Principles to determine how much above baseline operators should be allocated will need to be established, as well as a mechanism to reconcile unused funding

2.    If the wage leveling policy remains in place in the longer term, the provincial LTC funding model should be updated to reflecting the actual incremental cost of the increased wages
• This will require assessing the actual staffing costs incurred by operators to ensure that any subsidies are necessary and appropriate

3.    The ministry and/or HAs should continue to provide access to psychological health, wellness and safety supports to staff in the LTC sector
• MOH and HA’s should assess the supports currently in place and ensure they are sufficient and that there are no unnecessary barriers to access    

5.3    Long Term Recommendations

1.    Consider leveraging IPC practitioner positions, making them a resource available to care homes to support consistency across all provider types and standardized IPC practice across the sector. This should be considered as part of an HR strategy that includes other necessary positions as well. 
• The IPC practitioners should be well-trained and available during the emergency/pandemic and leverage existing public health resources during influenza season in LTC/AL homes to reduce the spread of infection
2     Moving forward, as new facilities are designed and built, the ministry and operators should consider leading practices in terms of pandemic response that may reduce vulnerabilities and susceptibilities to infection. 
• Examples of leading practice consideration include but not limited to, single beds, reduced shared spaces, updated ventilation systems, room layout and medical access (to isolation rooms) as well as designs to support residents with dementia or complex cognitive and physical needs
3    Consider having PHSA create a centralized repository of emergency stock for pandemic supply of PPE which would allow for full oversight across the system to mitigate any challenges for HA or operators to obtain supply in an emergency or pandemic response

4    Evaluate opportunities to improve access to the availability of real time supply chain data across the system to improve oversight, tracking and management of supplies

5    Address critical staff (care aids, PSWs) shortages by redesigning employment pathways that attract, train and retain staff to enable the professionalization of the workforce. Support staff within the sector to gain new skills and develop specialized expertise so that they see it as a career role (rather than a stepping stone) which may reduce high turnover rates currently experienced in the sector