Like most Canadians, I’d like to die in my home surrounded by friends and family.
Or second best, a home-like setting like the lovely Kamloops Hospice House. That peaceful setting is where my wife spent her last days as she was dying of cancer.
But contrary to Canadian’s wishes, only 15 per cent die at home.
More often we die in hospitals; more than comparable countries. Most Canadians, 61 percent, die in hospital. Far more than the Netherlands at 30 per cent. And although we like to boast about our health care system, only 20 per cent of Americans die in hospitals according to a report from the C.D. Howe Institute (Globe and Mail, Oct. 26, 2021).
We die in hospitals in the most unpleasant way, hooked up to tubes and machinery that unnecessarily delays the inevitable. Our lives may be prolonged slightly but the declining quality of life is hardly worth the price of suffering.
Canadian cancer patients have the highest rates of hospitalization in their last six months of life (87 percent), compared to England (83 percent), the Netherlands (77 percent) and the US (75 percent).
It’s so unnecessary.
Cancer patients whose condition is stable or reacting positively to treatment don’t require hospitalization. Those dying of cancer, as was my wife, typically require assistance with activities of daily living only in the final weeks or months of life. Terminal cancer patients differ from those dying of almost every other illness -those dying of other illnesses typically require assistance for many months or years before they die.
Older Canadian cancer patients are more likely to die in hospitals and less likely to receive palliative-care.
Palliative care primarily focuses on improving comfort and quality of life, often avoiding hospital-based, invasive, costly and potentially inappropriate care. Palliative care is preferably delivered outside of acute care settings, including in patients’ homes.
It’s not the fault of doctors in hospitals or because healthcare workers are unfeeling or uncaring. It’s because of the way the system is structured.
There are too few palliative care beds. Canada has one-half the number of hospice and palliative-care beds as the United Kingdom.
Treating patients at end of life in hospitals, rather than palliative care beds, is expensive.
Our per capita hospital costs are US$21,840. Canada’s costs are 18 per cent greater than that of the U.S., 100 per cent greater than Netherlands, and 233 percent higher than England. Canada’s relatively poor performance in terms of costs and quality of end of life care is clearly related to the high use of hospitals.
The authors of the report suggest the following remedies:
1 Canada must stop treating end-of-life care as acute care.
2 Palliative and end-of-life care must be provided across multiple healthcare settings. It cannot be the sole responsibility of hospices and palliative care facilities.
3 Training for clinicians, caregivers, even for patients must be provided recognize the end of life period.
We must have a frank discussion about death. Unless we know the signs of death’s knock on our door, we will be poorly prepared.