When home care providers are not available, who can patients turn to?

In Prince Edward Island, paramedics are helping to fill in the gaps.

Traditionally, the paramedic role has been to stabilize patients and transport them to the hospital. 

But in PEI, advance care paramedics — who tend to have downtime between emergency calls as well as flexibility to travel — are:

• providing support to patients after they return home from the hospital and are waiting for home care to kick in (doing things like changing dressings and administering medication); and
• providing services to palliative care patients living at home, specifically for pain and symptom management.

The latter service is available through the award-winning and nationally recognized Paramedics Providing Palliative Care at Home program, which was established in PEI in 2015 as part of the Provincial Integrated Palliative Care Program.

How the program works

Any time home care is not available — such as after hours — PEI residents can call 9-1-1 for palliative paramedic services.

When the ambulance arrives at a patient’s home, the paramedics will provide care and support based on a care plan developed by the patient and their health care team. This may include:

• providing additional pain medication or therapy to make the patient comfortable; and/or 
• consulting with a physician over the phone to determine the most appropriate treatment.

Sometimes the paramedic may recommend that the patient go to the emergency department, but the patient ultimately makes the choice.

According to the Program website, as part of this service the paramedic will also follow up with the patient’s health care team.

The paramedics working in the program have been trained by palliative doctors. While paramedics and palliative care physicians do not normally work together, this is one example of a unique collaboration that appears to be working for PEI residents.

Benefits

According to the Canadian Hospice Palliative Care Association, most Canadians would prefer to die at home, surrounded by loved ones. However, 70% of deaths occur in the hospital.

Ultimately, programs like the Provincial Integrated Palliative Care Program help to increase the opportunity for palliative care at home.

But there are other benefits as well. Increased access to palliative care in the patient’s preferred location helps to:

• reduce health care costs;
• reduce emergency department visits and hospital admissions; and
• increase quality of life — and provide peace of mind to patients and family members.

According to recent statistics, PEI paramedics had a total of 315 palliative care calls in 2016. Of those, 35% of patients were able to remain at home.

Future plans

Currently, paramedics provide palliative care on evenings and weekends. 

But in February 2018, the PEI government announced that it would expand program coverage to any time home care staff are unable to respond quickly. In addition, the province plans to create a paramedics’ check-in service for seniors, with the goal of reducing travel to emergency departments.

Having paramedics respond to palliative care calls is not supposed to replace the publicly funded and delivered home care systems. Rather, Health PEI has announced it intends to enhance the current system, by:

• making paramedics available more often; and 
• hiring more home care nurses.

For more information about Health PEI’s expanding programs for home care (with a focus on seniors and palliative care), click here.