1. Palliative Care - General Overview, WRHA Program, Opportunities to Support Rural/Remote Communities
Mike Harlos MD, CCFP(PC), FCFP
Professor and Section Head, Palliative Medicine, University of Manitoba
Medical Director, WRHA Adult and Pediatric Palliative Care
Nov. 1, 2017

2. The presenter has no conflicts of interest to disclose
Disclosure
The presenter has no conflicts of interest to disclose

3. Objectives Provide a general description of palliative care
Provide an overview of the WRHA Palliative Care Program
Explore how the development and provision of palliative care in rural/remote communities might be supported

6. An anticipated death should be a family and community event with the peripheral support of health care, rather than a medical event with peripheral involvement of family and community.

7. Palliative care is comfort-focused care and support for those affected by life- limiting illness – the patient, their family, their health care providers, and particularly in small rural and remote settings, the community.

8. Elements of Palliative Care
attention to comfort and quality of life
care is grounded in the “personhood” of the patient
who they are (or perhaps who they wish they had been, or who they hope to be)
their values, priorities, goals
consideration of the impact of the illness on family, friends, community
supporting involved health care providers with the emotional, ethical, and technical complexities of care
Arguably, these should be core elements of all health care
Palliative care includes the added context of a life-limiting illness

9. A palliative approach should be a thread in the tapestry of all health care - how dominant the thread is depends on the context, goals of care

11. Role of the Health Care Team
Anticipate predictable challenges
Communicate with patient/family
Formulate a plan for care

12. Increase capacity through education, advocacy,
Program development involves defining services that can be carved out of a broad philosophy of care with limited resources
Formal
Services
Palliative Care as a
philosophy of care
Resources
Increase capacity through education, advocacy,
partnerships

13. WRHA Palliative Care Program
Two streams of service delivery:
Registration on Program
Consultative Services

15. Acute Palliative Care Units
St. Boniface Hospital
15 bed unit
Access to tertiary care services
Riverview Health Centre
30 bed unit (2 beds currently closed)
Long term care facility

16. Hospice settings in WRHA
Grace Hospice
12 beds in stand alone facility near Grace hospital
RN staffing 24/7
Limitations in care that can be provided
Jocelyn House
4 beds in split-level home in St. Vital
Staffing – LPN/HCA with RN nurse manager

17. Care at Home
Majority of patients on Palliative Care program are in the community
Palliative patients in community have same service limitations as all Home Care clients
HCA and PSW services provided by Home Care Program
Families/caregivers must be very involved in providing care

18. How Might WRHA Palliative Care Help?
Will need to be guided by engagement with each community, listening to their unique priorities and goals
Some possibilities:
Contribute to the work of the new Shared Health Services Manitoba in improving provincial access to palliative care
Collaborate on educational initiatives
Participate in initiatives to provide clinical palliative care services
Contribute to guidelines/protocols

20. Guidelines Developed For Long Term Care Settings
Might be adaptable for use in rural/remote settings

22. Documents For Planning and Supporting Palliative Hospital Discharges Into Remote First Nations Communities

23. Tools
3 key components:
Guideline
Care Plan
Checklist