Caring at the end of life
While the Health Research Board has found that many terminally ill patients would prefer to die in a hospice than their home, the HSE has identified gaps in how they provide palliative care. Meadhbh Monahan looks at what they plan to do to close these gaps.
A “significant” number of terminally ill patients want to die in a hospital or hospice rather than their own home, a new report by the Health Research Board (HRB) has found.
These findings, released in the HRB’s ‘A Picture of Health 2009’ report will be acknowledged by palliative care providers and the HSE, which recently published its five year Palliative Care Development Framework outlining 41 national priorities. These will deliver over 272 new posts and 203 specialist in-patient (hospice) beds from now until 2013, to deal with the gaps in palliative care provision.
Interestingly, the HRB found that 91 per cent of the 58 patients who were interviewed at Blackrock Hospice opted to be cared for at home, but only a third wanted to die there. Another third said they would prefer to die in a hospice in-patient unit. A further 12.5 per cent were undecided while 4.5 per cent chose a nursing home. 4.5 per cent would like to die in a private hospital, 8.5 per cent would prefer a home or hospice and 4 per cent chose a hospital or hospice.
The HRB found that people generally don’t talk to their sick loved ones about death because “the subject is thought to be too sensitive and ethically challenging.”
The HSE development framework was produced with key stakeholders such as the Irish Hospice Foundation (IHF), the Irish Cancer Society and the Irish Association for Palliative Care.
Gaps
• There are eight dedicated specialist palliative care in-patient units across the four HSE areas but access to these is limited to proximity and three geographic areas (Athlone, Wicklow and Cavan) have no specialist in-patient units and no access to specialist in-patient beds for those patients most in need.
• There are six specialist palliative day care services nationally across the four HSE Areas, serving 2,600 people from 9am to 5pm. Access to these are also affected by proximity and the same three geographical locations have no access to this service.
• Current home help and public health nursing capacity is often insufficient to meet the needs of patients, with additional support provided by the Irish Cancer Society and the Irish Hospice Foundation.
• Non-cancer patients, e.g. those with renal failure and heart disease do not have the same access to night nursing services as those with advanced cancer.
• There are 50 acute general hospitals with 38 of these having varying degrees of access to dedicated specialist palliative care teams but there are significant variations in the staffing levels of specialist palliative care teams in acute general hospitals nationwide.
Developments:
Of the HSE’s 41 priorities, 12 relate to creating more jobs to meet home care deficits across the country, six relate to providing more specialist in-patient bed deficits, 15 relate to capital developments (including the building of nine hospitals) and eight relate to enhancing acute hospital support.
These developments will create better palliative care in every county, according to the HSE.
The implementation of the 41 priorities will cost €308.8 million. This equates to €237.3 million capital and €71 million revenue over the five year framework.
Chief Executive of the IHF Eugene Murray welcomed the development framework but warned that the HSE must strive to fund the framework despite the economic crisis because “ensuring a good death for patients should not be dependent on our economic health” and “investing in quality end-of-life care is not only good for patients but makes economic common sense.”
