Change in government brings no improvement in access to end-of-life care

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This article was published 08/03/2024 (587 days ago), so information in it may no longer be current.

TERMINALLY ill Manitobans have significantly less access to end-of-life health care than other Canadians, and the provincial government has done little to improve the situation since being elected last fall.

An analysis of palliative-care services across the country published in October by the Canadian Cancer Society revealed Manitoba has 1.15 hospice beds per 100,000 residents, the lowest per capita rate in the country. The cancer society says the number should be seven.

There has been no increase in hospice space in the province over the past 20 years, despite the end-of-life needs of the aging population.

Palliative care focuses on maintaining the highest quality of life while managing treatment and other needs. Hospice care specifically focuses on the six-month period before death.

Manitoba and Quebec were the only provinces that did not participate in the analysis last year. Quebec sent a letter declining to participate, while no one responded on behalf of the previous Progressive Conservative Manitoba government.

Since taking office last fall, the NDP government hasn’t made any promises about increasing hospice space, investing in palliative care or establishing a dedicated provincial strategy.

Health Minister Uzoma Asagwara said this week the government is open to hearing from experts to improve care.

“We know that end-of-life care is a very vulnerable time for families, and having access to palliative beds or hospice services is really critical,” Asagwara said.

“Since taking office, I’ve met with palliative-care specialists, nurse clinicians, experts, doctors in our own province, and the work to address this important, this crucial area of health care is ongoing. I look forward to continuing to listen to those on the front lines who deliver this care to make sure that we improve it for Manitobans.”

The cancer society report, published in late October, recommended that Manitoba develop a strategy to improve access.

There are just 16 hospice beds in Manitoba, all of them in Winnipeg: 12 at Grace Hospice on the grounds of Grace Hospital and four at Jocelyn House.

The Grace hospice was established by the Grace Hospital Foundation in 2004; there’s been no increase in space in Manitoba since then.

Addressing the shortage of hospice beds requires making palliative care a priority by recruiting specialists and establishing dedicated beds in each region of the province, said Dr. Christian La Rivière, a palliative-care and emergency-medicine physician in Winnipeg.

“Palliative care isn’t sexy,” he said.

An estimated 70 to 80 per cent of Manitobans will require palliative care, which translates to nearly 10,000 patients annually. Right now, only about 1,400 patients per year are enrolled in the palliative-care program in Winnipeg.

“We’re missing a large proportion,” La Rivière said.

Not all palliative patients require hospice care; some need home-care support to die at home or receive dedicated care from a doctor or nurse on a palliative ward.

But patients and their families want care that gives them the best quality of life possible at the end, he said.

“Dedicated hospice care allows for that to happen, if it’s properly funded and resourced,” he said.

Many people end up dying in hospital instead of being supported at home or in a palliative setting, and some patients turn to ERs because they have no other option, La Rivière said.

He noted it’s less expensive in the long run for the system to support palliative patients rather than have them rely on emergency departments or urgent care at the end stages of their life.

La Rivière said there has been a lack of political will to increase funding, and a lack of understanding within the health-care system.

There are palliative-care units at St. Boniface Hospital and Riverview Health Centre in Winnipeg, as well as programs in the Interlake and Southern health regions.

If there’s the will and resources to prioritize care, La Rivière suggested some of the existing palliative-unit beds could be repurposed into dedicated hospice space, and a telehealth palliative program could be established to help patients across the province.

Palliative Manitoba, a non-profit charitable organization through which volunteers visit dying Manitobans, is also calling for an increase in hospice beds.

“We definitely would like to see an increase in those hospice beds, not just in Winnipeg, but across Manitoba, because we know that the best possible hospice and palliative care is going to be provided in a person’s community, where they have that support,” said executive director Jennifer Gurke.

The organization wants holistic end-of-life care to be embraced by the system.

“Everybody in the health-care system really needs to have an understanding of what palliative care is, and how to practise it,” Gurke said.

— with files from Danielle Da Silva

katie.may@freepress.mb.ca