Thank you for giving Hospice Care Ottawa the opportunity to make this presentation today.
I'm here today to increase your awareness, I hope, about what hospice palliative care is and to ask you to address the growing need to support and fund hospice palliative care services in our community, whether they are at home or in some other setting.
Hospice palliative care is a philosophy of care that aims to relieve suffering and improve the quality of living and dying. There are many different settings for care, including people's homes, residential hospice, long-term care homes, retirement homes, and other institutions.
Our definition and understanding of hospice palliative care is adapted from the Canadian Hospice Palliative Care Association's “A Model to Guide Hospice Palliative Care”. It defines hospice palliative care as “appropriate for any [individual] or family living with, or at risk of developing, a life-threatening illness due to any diagnosis, with any prognosis, regardless of age, and at any time they have unmet expectations and/or needs, and are prepared to accept care”. It is a person- and family-centred approach respecting social, spiritual, and cultural practices. It includes end-of-life care, although it's not limited to that, and it's also not limited to the time immediately preceding death, so it can include bereavement and grief support.
This philosophy is perhaps best summed up by a quote by Dame Cicely Saunders, who is the founder of the modern-day hospice movement in London, “You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die.”
Who is Hospice Care Ottawa? Hospice Care Ottawa was formed in 2013 by the amalgamation of two smaller hospices in our city. We're a small, non-profit, community-based organization and we provide residential hospice care, volunteer in-home visiting, day hospice, bereavement support, and caregiver support. Our mission is to accompany and support individuals and their families through their end-of-life journey by providing compassionate, high-quality care. Our goals are to improve the quality of life for palliative care clients and their caregivers, and to reduce the burden on the health care system from unnecessary hospitalization.
All of our programs and services are provided at no charge to patients or their families, and we work closely with our local hospitals' home and community care organizations to provide and coordinate that care.
Currently we have some residential hospice beds in the city at two sites, but most of our programs are community-based programs. Last year we served over 360 people in residence and over 1,500 clients in the community. We provide our services with professional staff, but we do it primarily with the help of over 1,000 volunteers who last year provided over 50,000 hours of service and community support.
Hospice services in Ontario and in most provinces are not fully funded. At Hospice Care Ottawa, we receive less than 60% of our services from the local health integration network. That translates into us needing to fundraise almost $2 million a year just to provide our existing services. That's quite a feat for a small community organization. In addition, we have to fundraise the entire amount for any new builds or capital costs.
Last year Hospice Care Ottawa spent the majority of its budget, 76%, on direct programs and services rather than administration. As all charities know, fundraising is becoming increasingly difficult. This increases the administrative costs of charities. If we cannot raise sufficient funds from private donations, our existing services are in jeopardy. If we cannot increase our private funding, we cannot offer additional services such as those that are needed by particular communities of need, like the francophone communities in our area. It's inappropriate that the ability of Hospice Care Ottawa to provide palliative care in our community, which is an integral part of our health care system, should be in such a tenuous position.
Hospice Care Ottawa can and does provide a variety of alternative end-of-life services, but all of these options are underfunded, as I mentioned. In a recent study, Canada ranked ninth globally in a quality of death index. It is shocking to observe that only 16% to 30% of Canadians who die have access to or receive hospice palliative or end-of-life care services. Despite significant progress to advance hospice palliative care both locally and provincially, there continues to be this inadequate and inequitable access to comprehensive care. It is estimated that in our community there is need for hospice care bed services for six people out of 100,000 population. In Ottawa we have only 19 beds for a population of close to one million. Although we work really closely with our partners to ensure hospice care in the community, this continues to be a struggle.
In addition, we all know that our population is aging—indeed, that's part of the work of this committee—with the number of those age 65 and older to double in the next 20 years. Having increased numbers of seniors leads to more people using hospital and emergency rooms, which of course increases the cost to the systems and wait times. Those who are older are going to experience more chronic and life-limiting illness.
Hospice palliative care in the community is far less expensive than is hospital care. The Auditor General of Ontario noted that in 2014, hospice beds cost the system $460 a day, while acute care hospital beds cost over $1,100 a day. Hospice palliative care frees up much-needed acute care hospital beds and services. In Ottawa, our current services save the health care system approximately $4 million a year. Just imagine what we could do if we had more services.
Within the spectrum of hospice palliative care, there are some subpopulations with special concerns and unmet needs. For example, the lack of funding has made it very difficult to reach populations such as francophone, multicultural, and indigenous populations in our community.
In terms of the level of palliative care needs, we know that about 10% of all deaths are sudden and from an unexpected cause, such as an accident or a homicide. A further 30% will die with a steady decline in health status from a predictable or progressive disease such as cancer. The remaining 60%—and I would suggest this is a large part of our senior population—are people with advanced chronic illness, and they represent one of the main areas of unmet needs in palliative care. The vast majority of deaths arise from advanced chronic diseases such as heart disease, stroke, chronic obstructive pulmonary disease, renal failure, and Alzheimer's. The population is often the elderly experiencing a general decline secondary to physical and cognitive issues. They tend to be frail and unstable and to have those high-care and medical needs that sometimes require acute care. They are the large proportion of our seniors.
These are the patients who are filling our acute care beds. They do not need the expertise provided by acute care but are often too poor functionally or have symptoms issues that are too difficult for them to be properly managed in long-term care settings. When they are stabilized, they go back to long-term care, but as soon as they have an issue, they're packed into an ambulance and sent back to emergency rooms. The acute need is for services to care for patients within so-called chronic palliative settings, which I suggest is the majority of our senior population.
Most of what these patients need is personal care, such as washing, dressing, feeding, and toileting intermittently because they come symptomatic in some way. Our existing health care services are not responsive.
I'm probably done. Am I?