Abstract
Background: Despite 87 percent of Canadians expressing their preference for end-of-life care to be provided at home or a home-like setting, only 36% of Canadians have access to quality palliative services in this setting due to poor access, with marginalized groups facing even greater barriers, highlighting the need for new integrated models of care to ensure that all individuals, regardless of socio-economic status or background, can access dignified and compassionate care at the end of life. [1]
Hospital data in North Western Toronto (NWT), Ontario, Canada, an underserved community characterized by socioeconomic disparities, cultural nuances, and limited healthcare resources, revealed that 60%, 61%, 63%, and 64% of palliative inpatients died during hospitalization in fiscal years 20/21 through 23/24, respectively—significantly higher than the provincial average, highlighting the urgent need for accessible, compassionate palliative and end-of-life care in a community faced with significant challenges in obtaining this care.
Approach: To address these challenges in NWT, a cross-sectoral collaboration was initiated among hospital, hospice, and community partners to co-develop and test an innovative and integrated model of Hospice Care at Home (Hospice@Home). The collaborative engaged in co-design of a robust evaluation framework grounded in the Quintuple Aim to enhance the provider, patient and family experience, improve quality of care for palliative patients in community settings, ensure equitable access to high-quality services and optimize costs.
Hospice@home seamlessly integrates care across the continuum from acute hospital, community, including homecare and support services, and hospice to increase access and enhance the ability of those at end of life to receive care and die at home/ in a home-like setting, if they choose, including 24/7 clinical and psychosocial support (including grief and bereavement) to patients and their families, as well as access to palliative care physicians in the home. By working closely with local organizations and community leaders, the program strives to build trust and understanding, ensuring that services are aligned with the cultural and social values of the community and people it serves. Central to the model is an integrated care plan that addresses the holistic needs of patients, families, and caregivers. Community input led to the creation of a comfort fund, which alleviates financial barriers faced by the marginalized community in the NWT by providing patients with support for meals, transportation, respite, and medical supplies.
Results: One-year post-implementation, early results indicate positive outcomes, including improved patient and caregiver experiences, decreased emergency department and hospital utilization, and fewer hospital deaths among palliative patients, affirming the potential of Hospice@Home to address disparities in palliative care access.
Implications: This presentation will outline the Hospice@Home program, highlighting evolution findings, early lessons learned and the implications for future efforts to enhance integrated palliative care access through an equity-focused lens. The insights gained will inform ongoing improvements and the sustainability of this promising model in addressing the critical need for accessible, compassionate end-of-life care.
References
1.Quinn KL, Isenberg SR, Downar J. Expensive endings: Reining in the high cost of end-of-life care in Canada. SSRN Electronic Journal. 2021. Available from: https://www.cdhowe.org/sites/default/files/2021-10/Commentary_608.pdf