Mr. Speaker, I applaud the hon. member for bringing forward this very important motion. I want to suggest, however, that we add one amendment to the motion. I know that we are not allowed to do that, but I would like to include after the word “integrated” the word “comprehensive”. It is because it is not only about integrating a system of care we are talking about. It is about looking at all the elements of care that are necessary. The hon. member, in putting forward what is a broad-based recommendation, leaves it open for some of us to talk about areas that we feel are missing. The word “comprehensive” would encompass all of this.
The whole concept of palliative care is not a simple thing that happens when one's life is ending or when one is dying and wants to die a good death, as the word euthanatos means. What we are talking about here is the issue of palliative care as part of a continuum of care that should be divided, actually, into three parts. The three parts we want to look at have to be divided into the different levels of the end of life.
First, there are seniors ending their lives with chronic diseases who need to or can live in their homes. While those chronic diseases may eventually speed up their deaths, the point is that they are able to take care of themselves in their homes with a system that facilitates good home care.
The second part is a diagnosis of impending end-of-life, when the patient needs assisted care but is not yet dying.
The third piece we need to look at is the final piece, which is when the person is dying, which is when palliative care fits in.
Currently, palliative care and any of these levels of care are not considered to be core, mandated levels of care under the Canada Health Act. Therefore, they are spotty at best. We have some places where there is a wonderful integrated, comprehensive system in place and some places where there is practically nothing at all. That is why the motion is important.
The thing to remember is that 26,000 seniors die each day in Canada. Only a small percentage of them have the ability to get the kind of care they need as they lead up to and eventually end up needing palliative care.
The parliamentary committee, in 2011, had some excellent recommendations. As we develop a model to implement this, we can look at them, because some were quite comprehensive.
We need to talk about an integrated, comprehensive system, because we need to look at some areas that are not mentioned in the motion. One of them is support for caregivers. It is not only support for caregivers to take time off work so that they can look after the chronically ill and/or diagnosed patient. We need to have respite in place for caregivers. If caregivers are the only people on whom the care falls within the family, and they do not have an opportunity to take some time off to deal with some of the stress and emotional pain they have while they are looking after a loved one, we will not have fitted the system out properly. We would only consider burdening the actual family member with all the care and compensating them for it. Respite and time off is an important part of any support for caregivers.
I also want to talk about a piece that is not fully mentioned but that is really important. That is the issue of housing. I think we have forgotten that housing is a determinant of health and that housing is a core part of any kind of comprehensive and integrated system. As we get to the home care part, for instance, when people may be able to stay at home when they reach a particular point in their chronic disease and can still take care of themselves with help, we need to ask if we can retrofit homes. Do we have a program that would retrofit and renovate homes so that it would be possible for the person to live that period of their time at home?
Are we looking at new housing strategies through which people, once they get to the assisted living part, can move into an assisted living centre with all of the higher-level care that they may need, and eventually move on to palliative care in a facility particularly dedicated to palliative care?
The important piece that I would like to add is the comprehensive piece. We must talk about housing if we are to achieve that full system, and we must talk about respite if we are going to achieve proper support.
Pieces are missing. I support the intent, but there are pieces missing. For instance, we know that only 10 out of 17 medical schools in the country have any teaching program at all to train physicians in palliative care. Most physicians get something like a 10-hour course in those 10 universities, so most physicians are not really equipped to deal with palliative care.
The important thing is to look at how we educate and train caregivers, whether they are nurses, physicians, or others, to deliver appropriate care and to understand all of the pieces involved in end-of-life care, including the spiritual pieces, the cultural pieces, the emotional pieces, and all of that. We do not yet have that kind of training in place. That is one of the pieces that would be needed as we look at a comprehensive, integrated model of care.
The idea of helping people to develop a plan is very important. I think of the Canadian Medical Association meeting last summer. The doctors all talked about the fact that they did not do this very well, that they needed to start reaching out to their patients to talk about some sort of plan, and that patients need to understand that they can reach out to their physicians, or, if they are in a community care setting, to the nurse practitioners, the home care nurses, or whoever is looking after them to be able to discuss this matter openly.
The ideas here are excellent. I just wanted to add some elements to it that I think would strengthen it. That is why I wanted the word “comprehensive” in it. The mover of the motion may not agree with me, but after the word “integrated”, I would add “comprehensive” so that we deal not only with the health care system but also with other systems that would support it with palliative care.
That is what I had to say. I support the motion.