During his one-year Palliative Care Residency at McGill University in Montreal, Dr. Lorne Wiseblatt picked up on the fact that liaison nurses who were discharging patients from an institutional to a home setting often scrambled to find what services were available in different Montreal neighbourhood CLSCs (local community services centres). Some liaison staff lacked this information entirely, while others had made their own lists based on years of navigating the system. However, what information was available was not shared or easy to access. Compounding the problem was that some neighbourhoods offer more services than others, resulting in unequal access to care. Dismayed and surprised by these differences and the lack of a centralized system to house palliative home care services, Dr. Wiseblatt decided to research and compile this data as a research project, part of his residency requirement.
“I remember often times at the hospital, we’d be ready to discharge a patient home and we were working with the liaison nurse and the nurse would say,“Oh, we’re not sure what services are in this area of Montreal, or, we are not even sure if there are any home care or palliative care services in that region.” Also, certain areas have tons of services and certain areas have no services and I found that remarkable. I recognize how valuable it is to be able to spend the end of your life at home for as long as possible and the fact that certain people on the island of Montreal have different access based on geographic location; I find this unequitable. And the fact that the nurses were not sure and it was not easy to get the information, I thought we should do something to summarize the information as there was nothing shared on a centralized website.”
One of the driving forces behind Dr. Wiseblatt’s research project is the belief that palliative home care is an essential health service, a service which is likely to become increasingly important because of the rapidly aging Canadian population as well as the preference expressed by the majority of Canadians to die at home. The provision of home care services requires not only the delivery of care but the knowledge to know where and how to access services.
The objective of Dr. Wiseblatt’s qualitative research project was to conduct a comprehensive assessment of the palliative home care services that are available across each region in Montreal, and to provide up-to-date and accessible information for clinicians, as well as to identify any gaps in services. Dr. Wiseblatt interviewed representatives from 23 out of the 29 CLSC’s in Montreal to gather information on the home care system. The services available within the regions were compared to a “gold standard” of effective home care, as determined by best practice guidelines. His analysis found certain areas, particularly nursing care, to adequately meet many gold standard recommendations, while other aspects, such as the availability of inter-disciplinary healthcare professionals, required improvement. It found significant differences in the availability of services between regions. A summary of this data, organized by region, is available in English and French on the Palliative Care McGill website. This tool can be updated to accommodate new information.
Dr. Wiseblatt will finish his residency this summer and then start work half-time as a palliative care physician at The McGill University Health Centre (MUHC), and half time as a family doctor in a Montreal group practice clinic.
For more information on Dr. Lorne Wiseblatt’s research project, please contact the author directly:
lorne.wiseblatt [at] mail.mcgill.ca
For more information on the Palliative Care Residency Program at McGill University: https://www.mcgill.ca/familymed/education/postgrad/enhancedskillsprograms/pc