The Quality Hospice Palliative Care Coalition of Ontario
Working to ensure quality hospice palliative care in all care settings
from home to hospital, throughout the province.

The Quality Hospice Palliative Care Coalition of Ontario was formed in 2010 to bring together organizations, universities and research institutions working at a provincial level in the hospice palliative care field.

• Comprised of provincial associations and academic centres
• Coalition members represent over 900 health service providers working in palliative care including: Community Care Access Centres, residential hospice, visiting hospice services, long-term care homes, hospitals, retirement homes, and home care
• These health service providers employ over 10,000 regulated staff and 15,000 unregulated staff, and utilize over 14,000 volunteers in the delivery of care
• HPCO is the secretariat coordinating the work of the coalition

A Declaration of Partnership to Advance High Quality, High Value Hospice Palliative Care
Joint Priorities agreed to by MOHTLC, LHINs and Coalition Partners

Since 2011 the Coalition has been working collaboratively with Ministry of Health and Long-Term Care and the Local Health Integration Networks to review how hospice palliative care is provided in Ontario and identify priorities to achieve quality hospice palliative care for all Ontarians. This work resulted in a Declaration of Partnership that identified six priorities:

• Broadened access timeliness of access to hospice palliative care
• Strengthening caregiver supports
• Strengthen service capacity and human capital in all care settings
• Improve integration and continuity across care settings providing hospice palliative care (including the home)
• Strengthen accountability and introduce mechanisms for shared accountability
• Build public awareness... engage the public conversation

Within each priority area Coalition partners, LHINs, and MOHLTC agreed to dozens of action commitments deemed necessary to improve hospice palliative care. MOHLTC, LHINs, and Coalition partners are now working to carry out the action commitments from policy, planning, and service delivery perspectives.

Integrating a system of hospice palliative care that meets the needs of all Ontarians is a significant job but working as a Coalition in collaboration with government we can achieve our goal of quality hospice palliative care for all Ontarians.

Why is transformation of hospice palliative care needed?

• Meet the increasing demand for HPC services
• Enhance sustainability by delivering better value
• Un-silo the system

Hospice Palliative Care Facts

• The Canadian Hospice Palliative Care Association estimates that each death in Canada affects the immediate well being of an average of five other people, or more than 1.25 million Canadians each year.
• Only 2.9% of all deaths are sudden, however, there are at least 70% of Canadians who do not have access to palliative care (and when there is access, it is not equitable) (CIHI), (Carstairs, 2010)
• 1 in 3 Ontarians lives with one or more chronic diseases. Of those, almost 4 of 5 over the age of 65 have one chronic disease, and of those, about 70% suffer from two or more
• Even though cancer patients represent 28% of Canadian deaths (Statistics Canada, 2005), they make up 55% of referrals to CCACs for End of Life care (OACCAC)
• Seniors account for 75% of deaths each year (Carstairs, 2010) - many have non-Cancer diagnosis such as diseases of the circulatory system (35% of deaths) and of the respiratory system (about 10% of deaths) (Statistics Canada, 2005)
• Seniors make up the fastest-growing age group. In 2003, an estimated 4.6 million Canadians were 65 years of age or older, a number that is expected to double in the next 25 years.
• There will be 40% more deaths each year by 2020
• Polls suggest that 70 to 80% of Canadians indicate they would prefer to die at home if supports were available but the reality is that two-thirds (67%) of Canadians died in hospital (Statistics Canada, 2007)
• In home care in Ontario (CCAC), caregiver distress affects about one in five (22%) palliative care clients (interRAI, 2007 - 2009 data)
• In 2007/2008, 345,327 acute care bed days and 95,018 Alternate Level of Care (ALC) bed days were occupied by patients with a palliative care diagnosis
• In 2010/2011 Hospice volunteers gave more than 700,000 hour of care to over 21,000 individuals receiving hospice palliative care at home. Hospice volunteers provide emotional and physical care to the dying and emotional support and respite to family caregivers. Hospice volunteers also provide bereavement support to both patients and families before death and to families after the death of their loved one.
• 34% of ALC patients are in hospital because they seeking palliative care (Drummond 2011)
• 75% of deaths today still take place in hospitals and long-term care facilities.
• In Ontario, for those individuals admitted to hospital with a primary diagnosis of palliative, 6,927 (73%) died in hospital beds (IntelliHealth, MOHLTC, 2008)
• The average length of stay was 13.5 days (2008)
• The average age of these patients was 72.8 years of age
• 55.5% had two or more admissions before dying in hospital
• A residential hospice bed costs $439 per day to operate vs. at least $850 per day for an acute care bed. Government funding cover 56% of the daily cost of a residential hospice bed, the remainder is fundraised.
• There is a need for more and varied palliative care; at home and in residential hospices. (2012 Drummond Report, recommendation 5-77)

Provincial Hospice Palliative Care Review Documents

• Advancing High Quality, High Value Palliative Care in Ontario
• Ameliorer la Qualite et la Valeur des Soins Palliatifs en Ontario

Coalition Documents

• Creating an Integrated HPC System in Ontario
• Final Coalition Report With Appendices
• Cover Letter to Ministry
• Hospice Palliative Care Policy Brief to Government
• System Design Framework

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