Evidence of meeting #45 for Health in the 42nd Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was need.
A video is available from Parliament.
Senior Nurse Advisor, Canadian Nurses Association
It's important to highlight the caregivers as well.
Liberal
John Oliver Liberal Oakville, ON
In the proposed legislation, it says identify “measures to support palliative caregivers”. That's paragraph 2(1)(c). Is that sufficient for non-registered health care providers?
Senior Nurse Advisor, Canadian Nurses Association
We saw that one as sufficient.
Executive Director, Canadian Hospice Palliative Care Association
Yes. I just need to mention that the training for health care providers and caregivers is totally different. It's not the same type of training, but they're both really important.
Executive Director, Canadian Hospice Palliative Care Association
The training we would provide for health care providers who provide hospice care and the palliative approach to care is a totally different training model from what you would provide for caregivers who are helping care for those who are dying. It's different and we actually have some models in this country, so somehow we have to get the language so that it's clearly.... They're both very important, but they're different.
Liberal
John Oliver Liberal Oakville, ON
There is a report that says that out of 77,000 physicians, there are only 51 palliative care specialists and only 123 family doctors who have training in palliative care. Also, out of 360,000 RNs, 1,348 have certification in palliative care. My sense is that we need to do broad training of health care providers, and I'm sure, other categories as well.
The last question I have is in the concept and definition. When does palliation end? I've heard from some families, particularly who have come through hospices, that they've had tremendous support through death, but as soon as death occurs, they're done. In terms of the bereavement and closure for families with the caregivers who were side by side with them through the death of a loved one, it's an abrupt loss. Are you aware of any models that extend palliation to some kind of closure and bereavement process for families?
Executive Director, Canadian Hospice Palliative Care Association
The existing hospice palliative care programs spend a lot of time on bereavement and actually try to carry the bereavement past the point of death, but they're not funded within the health care system, so it's done by those programs and it is not done by the programs that aren't doing it.
Really quickly, one of the things you can do.... The compassionate care benefit—the federal benefit that we have all endorsed—ends the day your family member dies, and we've asked for them to extend it for a period of two weeks. It makes sense. They're looking into it. We heard that they took our repeated letters seriously, and they're going to look into it.
We have to pay attention to bereavement. When you don't do the service well and you don't provide support to family members who are bereaved, they end up in the health care system themselves, so it's very important.
Thank you for asking the question about bereavement.
Liberal
Conservative
Len Webber Conservative Calgary Confederation, AB
It's one round now.
Can I just have a little bit of a rant here for a minute?
We have probably two of the top experts on palliative care in Canada here presenting to us, and we've had to cut Sharon off of her presentation. Now we're only going to give them seven minutes each to present to us. I find that disappointing.
We've tried to shorten down our study here on palliative care by limiting the witnesses and cutting down presentations. To me, I just think we're not doing a thorough study by doing that, so I'm just disappointed. I wanted to express that and now I feel better expressing that.
Conservative
Len Webber Conservative Calgary Confederation, AB
No. I'm still raving here, Mr. Chair.
I just need clarification. We have seven minutes for the Conservatives to ask questions, and that's all.
Liberal
The Chair Liberal Bill Casey
We have two panels. We can't get through everything if we do four rounds of questions.
Conservative
Len Webber Conservative Calgary Confederation, AB
Why are we doing so many panels on one day, then? We should have two hours with Ms. Baxter and Ms. Roussel. I don't know why we have to be in such a hurry. They've made a great effort to come here today, and we are just cutting it short. I'm very frustrated by that. This is an important study. It's an important bill.
Thank you for listening to my raving. You can start the time now. Actually, it's not funny.
Anyway, thank you Mr. Chair. Thank you, Josette and Sharon, for being here today.
Thank you, Mr. Oliver, for bringing up the bereavement portion of care and palliative care. I think it is incredibly important that there be bereavement support out there and that it be funded. It's of key importance to the families who are survivors of their lost one.
I want to bring up another important issue, and that is spiritual care for patients who are in palliative or end-of-life care. I think it is incredibly important to have it. Cancer advocates, patients, and caregivers are raising concern in Alberta right now about a decision that Premier Notley and her NDP government have decided to implement, and that is to remove spiritual care from the funding of palliative care. I find that to be an extreme shame as well.
My question to both of you is this. How important do you think spiritual care is in the spectrum of palliative and end-of-life care?
Executive Director, Canadian Hospice Palliative Care Association
We have national norms and standards for hospice and palliative care that were developed in 2002 and revised in 2012. They came up with nine domains of care that are important to deal with when the patient is getting near the end of life. Only one is medical care; only one refers to pain and symptom management. The other domains refer to spiritual care, psychological care, grief and bereavement, and.... I won't get into them all because I likely won't remember them all, but there's a lovely little chart.
They're all equally important. When somebody's in the last stages of life, it's not necessarily just pain and symptom management—the medical side of things—it is the spiritual care, and it's very important. I hadn't heard that about Alberta, but the model of specialist care includes physician, social worker, spiritual care adviser, maybe an occupational therapist. It needs to be whatever is needed, and it needs to be comprehensive.
Senior Nurse Advisor, Canadian Nurses Association
The quality of palliative care is best when it's offered through a team-based approach, and spiritual care is a part of that approach and very important. Nurses know that first-hand, when we are listening to our patient's conversation at three o'clock in the morning, when they're in distress.
Distress has different meanings, especially when you are living those circumstances of end of life. You are either having physical symptoms of distress, or it could be spiritual. It could be symptoms that you need to discuss. It's part of a quality palliative approach to care.
Conservative
Len Webber Conservative Calgary Confederation, AB
I completely agree with you. It's just shocking that Notley is cutting funding in that area.
I don't know how much time I have left—
Conservative
Len Webber Conservative Calgary Confederation, AB
—but I have to share now. I will pass on to Dr. Carrie.
Conservative
Colin Carrie Conservative Oshawa, ON
Thank you very much, Len.
Thank you very much, Mr. Chair, and thank you very much to our witnesses today. This is so important.
I want to get right to my questions. My first one is to the CNA.
You mentioned expanding the training for health care providers. What leadership role have you taken, in the nursing profession, to get that extra certification or specialization? I know some other professions are working on things, but could you give us some examples of what you think are important when you're looking at how to integrate it and looking at the state of training?
Senior Nurse Advisor, Canadian Nurses Association
Currently we see gaps, and we're actually working with the Canadian Partnership Against Cancer on nationally examining educational gaps for all professionals: nurses, physicians, and other professional groups. We haven't completed our survey, but we're finding that there are gaps. We certainly see that this is an issue that we should address earlier on in the curriculum and integrate this aspect of care early, before the professionals are practising.
Of course, what we've done as an association is to provide nurses with experience in hospice palliative care the opportunity to gain a national certification. It provides them with a specialist title and certification that's nationally recognized. We have 1,400 nurses. They're specialized. It's not enough; we need more. Of course, we're promoting the certification program and attracting employers to really enhance the uptake of this certification. It has a lot of benefits.
Continuing education is very important. Right now, before I came to do the presentation, I was just reviewing the current programs available, and there are very few. There are some in Ontario, certificate and post-certificate programs for nurses, and there is one in Quebec, but I saw it was closed for this year. Very few programs are available, and nurses have to manage continuing education by their employers. Pallium is a program that's really been successful in reaching out to teams and nurses. Virtual Hospice is another great resource for nurses, but we can do more, of course.