These paramedics are helping give Canadians the choice to die at home

Categories: Care and In The Media.

This article was originally published on CBC by Brandie Weikle.

Paramedic Matt Rousselle makes his way to the front door of a modest, two-storey house in Arnprior, Ont., in the Ottawa Valley.

There’s no siren, and he’s not here to administer the emergency medicine that most of us think of when it comes to paramedics. He’s not even travelling in an ambulance.

Rousselle is a community paramedic, and he’s here to check on 94-year-old Billie Hobbs, who is experiencing end-stage heart failure.

“We’re going to see a palliative patient — she’s a newly deemed palliative patient — just to go see how her daughter is handling everything, and see how the patient’s doing,” Rousselle tells Dr. Brian Goldman, host of White Coat, Black Art, during a visit to the Hobbs residence last summer.

Goldman has travelled to the area to see first-hand a program that’s bringing badly needed care to people with limited access to doctors and hospice beds in the final days of their lives.

Palliative care, which aims to ease suffering and improve quality of life, is in short supply both in sparsely populated areas like the one where Hobbs lives and larger urban centres. A Canadian Institute for Health Information report found that most Canadians with a terminal illness would choose to die at home if they could access palliative care, but only 15 per cent are able to do so.

“If we’re behind in one area, it’s really giving the support to family caregivers that is required to allow a successful home death,” said Prof. Barbara Pesut, who studies equitable access to end-of-life care and holds the Canada Research Chair Canada in health, ethics and diversity.

Pesut says different jurisdictions have come up with some creative ways to tackle the problem in recent years. Among them are programs that enable paramedics to provide care to palliative care patients at home, as well as invaluable support to their families.

In the sprawling Ottawa Valley — like other rural and remote areas that comprise much of the country — many patients, including frail seniors and people with cancer, don’t have family doctors or nearby walk-in clinics. The ER is often the only place where they can get medical care.

But the County of Renfrew Paramedic Service has started to fill in some of those gaps for palliative patients at home, with paramedics like Rousselle working on teams that include the patient’s family doctor, pharmacist and home-care workers.

Staying out of the hospital

Before this program got underway, Rousselle and his colleagues were limited in the help they could offer the palliative patients they encountered on 911 calls, he says.

“It was quite difficult before because you’d always have to call a physician and they would always say, ‘transport to the hospital.’ And this is … a lot better,” said Rousselle.

“I don’t think anybody really wants to die in a hospital. These people are at a point in their life, where they know the end is coming. And they feel like they’re losing control. And if you can put that control back in their hands, determining how they want to die, where they want to die, I think that’s the best outcome for the patient and the family as well.”

There are similar paramedic programs in other parts of Canada, including in parts of British Columbia, Alberta, Prince Edward Island, New Brunswick and Nova Scotia, says Pesut — with more on the way. This spring, Ontario’s Ministry of Health announced a pilot program that gives paramedics in 33 municipalities the authority to administer some palliative medications, including opioids like morphine, as well as sedatives.

Keeping pain under control

Getting pain under control is the first step to keeping palliative patients comfortable at home, said Rousselle.

Another big part of his job is ensuring the patient’s family caregivers are able to cope. “They’re the support unit for that person, and if they can’t handle it, that patient has no chance of getting through this [at home].”

Rousselle asks Billie’s caregiver, daughter Susan Hobbs, how she is managing with administering her mother’s morphine through the port in her right arm.

“OK. I have a steep learning curve, but I accomplish things over the days and do learn how to do this better,” she tells him.

Susan tells Goldman she’s on duty “24-7” apart from brief periods someone else is covering her and Billie is asleep.

“Right now I want to be near her because the signs can be subtle that there’s discomfort. I’m not leaving her alone for too long at a time.”

An alternative to calling 911

The program is the brainchild of Mike Nolan, chief of the County of Renfrew Paramedic Service. For years, he’s been pushing for community paramedics to provide palliative care.

He says palliative patients who wish to die at home often end up in hospital because family members call 911 when something abruptly changes in their condition, such as laboured breathing, seizures or increased pain.

The idea with this program is to get the word out that there’s “an alternative to calling 911 if something changes,” said Nolan. Once connected to the program, patients and families get number to call for round-the-clock access.

Nolan said the intention isn’t for paramedics to take over palliative care, or become the primary care providers for these patients, but instead to help address the forecasted critical shortage in palliative care providers stemming from an aging population.

“And we believe that paramedics have the knowledge, skills and ability to be able to contribute in a meaningful way, 24 hours a day, seven days a week, no matter where you are in the community.”

More care needed for aging population

Pesut, who is also a professor of nursing at the University of British Columbia’s school of nursing on the Okanagan campus in Kelowna, B.C., says Canada has made good strides to improve palliative care in recent years, including the development of a national framework in 2018.

That’s critical given that Canada’s population is aging, she says. “And they’re aging with multiple complex chronic illnesses, which add to the complexity a fair bit.”

She says it’s been an uphill battle over decades to get decision-makers to pay attention to palliative care, and access still needs to improve.

“It depends on two things: your socioeconomic status, and where you happen to live,” said Pesut, who holds a PhD in nursing. “If you’re wealthy, what you can’t get through the public system you can typically buy and pay for.”

Back in the Ottawa Valley, Susan Hobbs says her mother passed away peacefully at home just three days after White Coat, Black Art visited her with paramedic Matt Rousselle.

In nearby Eganville, Ont., Laurie Dodge was also able to lean on the County of Renfrew Paramedic Service while caring for her uncle, Leo St. Jacques, who died at home Feb. 28 after a long struggle with emphysema.

“They even helped us with getting a bed for him, getting nurses in here for me to help, because it was only just him and I,” said Dodge.

“With this new program they have, I’m telling you, it’s just amazing. I can’t stress that enough. My uncle wouldn’t have been able to stay at home … if it wasn’t for them. It was the world to him.”

Dodge said her uncle’s final days were quite comfortable.

“He liked his old Westerns. And he got to have an eggroll or two before; that’s what he was asking for.

“And he kept saying thank you, thank you. He just wanted to be here and at peace.”

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