Full Title: The Pan-Canadian Gold Standard for Palliative Home Care: Towards Equitable Access to High Quality Hospice Palliative and End-Of-Life Care at Home. Bilingual booklet. Published 2006.
The gold standards provide the benchmarks for high quality hospice palliative care at home. They are based on the National Principles and Norms of Practice for hospice palliative care, developed by hospice palliative care providers, organizations and consumers through a consensus building process led by the Canadian Hospice Palliative Care Association. The Need Most Canadians with life-threatening illnesses would prefer to die at home surrounded by family and friends, yet about 75% of deaths in Canada still occur in hospital or long-term facilities.i The gap between Canadians’ preference and current practice in the health care system is due to a number of factors, including lack of awareness of hospice palliative care servicesii available to people in their homes and the wide variation in the type of hospice palliative care services provided by home care organizations in different jurisdictions. The Commitment In 2004, in the 10-Year Plan to Strengthen Health Care, governments recognized the need for hospice palliative care services in the home. In that plan, the federal, provincial and territorial First Ministers made a commitment to “provide first dollar coverage by 2006 for certain home care services … [including] case management, nursing, palliative-specific pharmaceuticals and personal care at the end of life.” Why a Gold Standard? To support provincial and territorial government efforts to fulfill their commitment, the Canadian Hospice Palliative Care Association in partnership with the Canadian Home Care Association has defined the “gold standard” for each of the four home care services to be funded by government: case management, nursing, palliative-specific pharmaceuticals and personal care at the end of life. Our goal is to ensure all Canadians have equitable access to high quality end-of-life care at home. To develop the gold standards, the two associations consulted with experts in hospice palliative care, experts in home care, and a wide range of professionals who would be part of hospice palliative care teams, including physicians, nurses, pharmacists, personal care workers, social workers, case managers and home care administrators. Draft standards were reviewed by individuals across Canada with appropriate knowledge and expertise, and revised based on their feedback. The gold standards provide the benchmarks for high quality hospice palliative care at home. They are based on the National Principles and Norms of Practice for hospice palliative care, developed by hospice palliative care providers, organizations and consumers through a consensus building process led by the Canadian Hospice Palliative Care Association.iii The gold standards establish the ideal level of care and support that all jurisdictions should strive to provide for people receiving hospice palliative care at home. They are designed to encourage and support a consistent approach across the country to hospice palliative care services at home. A Call to Action The gold standards set out the desired practice and the vision for excellence for hospice palliative care at home. As government policy makers, home care leaders and clinicians implement the 10-Year Health Plan, we encourage them to use these gold standards to ensure their citizens have access to comprehensive high quality hospice palliative care at home. To achieve these standards, we recommend that all jurisdictions: Adopt strategies that will give their citizens timely access (i.e., 24 hours a day, seven days a week) to hospice palliative care at home – including appropriate pharmaceuticals and equipment — so they feel confident that they can choose to die at home; Establish interdisciplinary hospice palliative care teams that make effective use of the skills of each member to support clients/patients and families/caregivers; Support ongoing hospice palliative care education for members of the health care team and family caregivers; Invest in home care case management and information systems that support the interdisciplinary teams and provide information that can be used to evaluate home care services at end of life; Support ongoing research into good practices for hospice palliative care at home, including the cultural, ethical and spiritual aspects of care. We recognize that provinces and territories are at different stages in developing home care services for clients and families requiring hospice palliative care. Some may already be delivering gold standard care; others may still be working to define or refine their services. While the gold standards encourage consistency, they do not imply uniformity. Jurisdictions may differ in the policies, procedures, strategies and staffing models they use to provide home care; however, their goal should be the same – to provide home care services that meet the gold standard in hospice palliative care in order to relieve suffering and improve the quality of living and dying for people at end of life. i. Carstairs. Quality End-Of-Life Care: The Right of Every Canadian. Final Report to the Senate. June 2000. ii. This paper refers to hospice palliative care services and palliative home care services. The language used in the 2004 10-Year Plan to Strengthen Health Care refers to palliative home care; however the preferred term in the field is hospice palliative care. iii. Ferris FD et al. A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. Canadian Hospice Palliative Care Association.
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