In Quebec.
Evidence of meeting #19 for Medical Assistance in Dying in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was patients.
A video is available from Parliament.
Evidence of meeting #19 for Medical Assistance in Dying in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was patients.
A video is available from Parliament.
9 a.m.
Conservative
9 a.m.
Conservative
Dominique Vien Conservative Bellechasse—Les Etchemins—Lévis, QC
Dr. Dechêne, what is difficult, is it accessing home care or is it accessing home-based palliative care?
9:05 a.m.
Family Doctor, As an Individual
Thank you for that fantastic question.
In Quebec, we have local community service centres, called CLSC. They are wonderful places, which offer excellent home care. They have nurses, occupational therapists and physiotherapists on staff. Every category of health professionals is represented, apart from doctors. It's absurd, I know.
For purely political reasons, and probably union-related ones, for 35 years now, doctors have not been included in this exemplary multidisciplinary health care model which is the CLSC. However, in the case of palliative care, we can't offer it without doctors. I am not talking about a person's last seven days on earth, but rather of palliative care, which is comforting care given during the last year of life, as I stated earlier.
For example, let's say we have a person who suffers from heart failure, which patients, who frequently find themselves choking, sometimes call “water on the lungs.“ The medication dosage has to be changed constantly, whether administered intravenously or orally. We change the dosage from one day to the next, and sometimes twice a day. It can be done over the telephone, or during one of our visits, so that we make sure that the patient enjoys a good quality of life and does not choke.
What can our wonderful home care nurses do...
9:05 a.m.
Conservative
Dominique Vien Conservative Bellechasse—Les Etchemins—Lévis, QC
Dr. Dechêne, I have very little time.
You're speaking of...
9:05 a.m.
Family Doctor, As an Individual
As I just said, the problem is that there are no doctors in the CLSCs.
9:05 a.m.
Conservative
Dominique Vien Conservative Bellechasse—Les Etchemins—Lévis, QC
You said this was for political reasons and also union-related ones. According to you, there is a seemingly simple and much less costly solution.
What is the problem, in this case? I'm having trouble wrapping my head around it. I would have thought that it might rather be a question of training, or doctors having the necessary skills or being sufficiently at ease with offering this type of care.
9:05 a.m.
Conservative
Dominique Vien Conservative Bellechasse—Les Etchemins—Lévis, QC
You spoke of political reasons and union-related ones.
9:05 a.m.
Family Doctor, As an Individual
Yes, absolutely.
I really liked Dr. Downar's comment when he explained that actually, palliative care constitutes an improved practice in all care settings, not only at home. Not all family doctors, such as pediatricians, for example, can say that they are experts in palliative care, especially in a home setting.
The problem is not training, however, because doctors can't even be hired in order to offer palliative home care through our CLSCs. There is a fundamental problem here.
9:05 a.m.
Conservative
Dominique Vien Conservative Bellechasse—Les Etchemins—Lévis, QC
If I understand you correctly, the government has the solution within its reach, but as you say, you have not been able to convince it to make home care a priority.
9:05 a.m.
Conservative
Dominique Vien Conservative Bellechasse—Les Etchemins—Lévis, QC
You waxed lyrical about the Nova Home Care program.
What is it exactly?
Can it be used elsewhere in Quebec? I think that is what you are looking to do, from what I understood.
9:05 a.m.
Family Doctor, As an Individual
That's correct.
In English-speaking Canada, Nova is a well-known organization because it is now a distinct subsidiary of the Victorian Order of Nurses, the VON, whose wonderful community nurses support the public health care system's home care nurses. The VON is already present in almost all of the English-speaking provinces in Canada.
Our equivalent of the VON is called Nova Home Care. The organization offers tremendous support and knowledge to nurses who are already offering home care through our CLSCs.
To come back to your question, you are indeed right, we would certainly be happy if community nursing groups specializing in palliative home care could offer their support and mentorship everywhere in Quebec.
9:05 a.m.
Conservative
Dominique Vien Conservative Bellechasse—Les Etchemins—Lévis, QC
How could that happen, Dr. Dechêne?
I understand that only Verdun's CLSC benefits from this support, and that is in an urban setting. Am I wrong?
9:05 a.m.
Family Doctor, As an Individual
Nova Home Care is already working with 19 CLSCs in the Greater Montreal region. There are other nursing groups, such as the Palliative Home-Care Society of Greater Montreal, in the eastern part of Montreal. Unfortunately, these expert nursing groups do not offer their services in many regions in Quebec because they do not all enjoy the same accreditation or subsidies for the important work that they do.
By the way, Nova Home Care and other similar groups cost less to the health care system than the nurses working within the public system. They actually represent a very interesting model that could help the public system.
9:05 a.m.
Liberal
Élisabeth Brière Liberal Sherbrooke, QC
Thank you, Madame Joint Chair.
I would like to thank all the witnesses for being here.
Doctor Dechêne, thank you for your comments. I would like to ask you a particular question without using up all my speaking time.
You are making a distinction between a family medicine practice and a CLSC by stating that there are no doctors who work in the CLSCs, is that correct?
9:05 a.m.
Family Doctor, As an Individual
Yes, absolutely. They are two completely different entities. You're right.
9:05 a.m.
Liberal
Élisabeth Brière Liberal Sherbrooke, QC
Thank you.
You said that expert care is required. Can you explain to us in concrete terms what palliative home care requires in terms of resources?
9:10 a.m.
Family Doctor, As an Individual
Thank you for that excellent question.
As a practitioner of family medicine, you can have an enhanced practice. You don't have to go back to medical school, but rather undertake a two to three month-long practicum, and then be supervised by your peers, i.e., doctors who do this type of work, for a three-month period. After these two three-month periods, a doctor is able to practise in a different area than family medicine.
I also have my own practice. My pager does not buzz at 2:00 a.m. for my practice patients. They are not hemorrhaging, they are not choking and they are not crying out in pain at 2:00 a.m. They are in a very stable condition and suffer much less, overall. I would say that it's almost a hospital practice in a home setting.
When we work at the hospital, we are woken up at night for our patients who have been hospitalized. The same thing goes for home-based palliative care. I really want to underscore this point: patients whose condition is unstable and who need complex medical care need to have a doctor on call 24 hours a day, otherwise they will just keep on going to the ER.
I would like once again to say thank you to Dr. Downar. This is the biggest medical crisis the health care system is facing everywhere in Canada.
If only you knew, Dr. Downar, how much worse it is in the province of Quebec.
Our statistics on deaths in the home show this, because we only have 12% of deaths taking place in the home. It is a very low percentage, compared to what we see elsewhere in Canada, which is 30%.
9:10 a.m.
Liberal
Élisabeth Brière Liberal Sherbrooke, QC
Thank you.
So what do we need in practical terms? Let's say that I'm coming to the end of my life and I'm living at home. Will a nurse come stay with me 24 hours a day?
9:10 a.m.
Family Doctor, As an Individual
No. As I said in my presentation, caregivers play an active role. This means that hospital-based doctors may not be comfortable with home care if they do not have a framework and are not supervised. Caregivers are given the responsibility of administering opiates by injection, giving medication and checking vital signs. Of course, not all patients can stay home until the end, but we manage to keep between 64 and 65% of patients at home and we accompany them until the end.
The nurses are already working. We have them everywhere in Quebec and they are extremely competent. They are fantastic, consummate professionals. They have a bachelor's degree and are trained in palliative care, but who can they call at 9:00 a.m. on a Friday morning if the patient is choking, when there is no on-call medical staff 24 hours a day, which for us means an intensive palliative care team? That is what we are lacking in Quebec.
9:10 a.m.
Liberal