Blog

This commentary has been provided by Barry R. Ashpole of Guelph, Ontario.

Two important human service issues have emerged in recent years and continue to generate a great deal of attention in both the political and public arenas:

1) the pressure on the public purse for the future provision and delivery of health care and social services to the population-at-large; and,

2) meeting the needs of the elderly, who are living longer, in greater numbers than in past generations, and with a corresponding increase in the incidence of chronic or long-term illness or disability.

Running parallel is the trend in many countries away from institutionalized care to accommodate the preference expressed by many people to receive care and support in their own home in the event of illness or incapacity. The potential economic benefits of that approach have not escaped policymakers, presenting them with a persuasive argument that suggests a significant shift in the focus and scope of community care in the decades ahead. Against this backdrop is the increasing attention on all fronts given to the quality of care and support for those living with a terminal illness, both patients and their families or loved ones. People living with a terminal illness in rural communities and remote regions, however, present a unique set of challenges; compared to urban centres, there are significant – but not necessarily insurmountable – disparities in access to quality end-of-life care.

According to the 2011 Census, more than 6.3 million Canadians were living in rural or remote regions. At 18.9% of the population, this number has been relatively stable since 1991. A trend in recent years, however, has seen elderly city dwellers relocating to spend their retirement years in rural communities. Little is known about the perspectives of people living in these areas on what constitutes a “good death” and how this might be accomplished. A critical consideration, supported, literally, by volumes of research, is the wish of most people living with a terminal illness to be able to die at home. At the present time, the likelihood of receiving specialized home care services such as palliative care are markedly low in rural communities and remote regions.

In Ontario, as in all other provinces and territories in Canada, there are barriers to providing hospice and palliative care outside of urban centres, for example: 1) the lack of services; 2) health professionals unfamiliar with the philosophy and practice of palliative care; 3) limited access to resources; and, 4) continuity in the provision and delivery of care. And, more often than not, these barriers are even more pronounced among First Nation’s communities. Unfortunately, there is little strong evidence to inform policy and service development. Models of end-of-life care, however, do exist despite a general lack of health care professionals inexperienced or trained in end-of-life care and the resources to support them, their patients and patient families.

There is a clear need to initiate a province-wide dialogue, raise public awareness in the process, and address this issue at the local level. Many of the most successful hospice and palliative care programs in Canada have had their roots in community initiatives. Professional education and public awareness – and improved access to information and resources – are critical. Ultimately, the goal is to effect change at the policy making level of government, but there is much that communities can do now to address this public health issue.

About the blogger

My involvement in hospice and palliative care dates from 1985. As a communications consultant, I’ve been involved in or responsible for a broad range of initiatives at the community, regional, provincial and national level. My current focus is on advocacy and policy development in addressing issues specific to those living with a terminal illness – both patients and families. In recent years, I’ve applied my experience and knowledge to education for frontline care providers, developing and teaching on-line and in-class college courses on different aspects of end-of-life care.