Most seniors say they want to die at home. However, about half of seniors are dying in hospitals, according to research by Verena Menec, the Director of the University of Manitoba's Centre on Aging. She says many of these patients don't need to die in the hospital. They could be dying in more comfortable settings if we had the services to provide them. But often, we don't.
Menec, who is also an expert with EvidenceNetwork.ca, says hospital care isn't structured to treat frail, elderly patients with chronic illnesses. "It's very stressful to the person who is dying in that setting but it can also be very stressful for the family," Menec says. Many patients bounce in and out of emergency rooms several times at the end of their lives.
"Imagine a 90-year-old person, coming in, frail, confused. They're coming through an emergency department and they die in an emergency department. There's no family, there's that whole bustle of the emergency department," Menec says. "I think that's really sad."
Given the numbers, it seems a daunting task to grant a senior's wish to die at home. Dr. Louise Coulombe set out to meet that challenge when she founded a home care palliative care practice in Ottawa.
She drives around the city delivering palliative services to patients in their homes. Back at her office, the computerized management system calls out the names of patients who are due for a visit. The cold, digital voice contrasts with Coulombe's description of her very personal interaction with patients.
"You basically see people in four dimensions at home. You walk in and immediately you know they're different from everybody else. You see them in depth, not just where they are now but where they have been."
Coulombe gets into her car to visit 89-year-old Russell Peacock, a man with thyroid cancer who lives alone in a small bungalow. Coulombe calls him a great talker. As soon as she arrives he launches into a story. "Oh I had a terrible day today. Yesterday I mean. I went shopping with my brother ... He was exhausted and so am I." Coulombe interrupts his tale repeatedly to tell him to sit down, not to tire himself out further.
Peacock could live from three months to six months or more.
"Well here I am. I don't know how long it'll be but I don't care. You just live it day by day anyway. You know? Live everything day by day." He's lived in this house since shortly after he returned from serving in the Second World War. He still remembers the date he moved in, October 13, 1947.
"Fifty-four years I've been here. Oh jeez, imagine that. A whole life gone." Peacock's wife, Vera, died here and this is where he'd like to stay. "So we stayed here and I'm still here. Still keeping me in my house. Between the doctors there and palliative care I can handle it, you know?" he says, laughing.
Dr. Coulombe says our medical system is slowly changing to accommodate practices like hers.
"We started to feel that we could conquer death and we're learning, in the last fifteen, thirty years that we can't. And we're beginning to see that this is part of life. Before it was separated completely and you died in a dark place in a hospital and that's how you did it in this society."
Advocates like Sharon Carstairs say the strain on the system will be damaging if we don't change how we deliver health care -- and soon. "We're actually going to go backwards unless we make a significant change in the way we deliver care." Carstairs retired from Canada's Senate after 17 years advocating for a bigger focus on palliative care. She says we need to reinvent the health care system to avoid debt from rising costs.
"We need more doctors, we need more nurses, we need more health care professionals generally who are trained in palliative medicine. We need greater research and we need home care," she says.
Hospital deaths are also a cost issue; full beds can cost the Canadian system about a thousand dollars a day in hospital, compared to about fraction of the cost in a long-term care institution. By the Ontario Home Care Association's estimate, a long-term care bed can cost as low as $126 a day. Home care can be even less expensive depending on the type of care the patient needs.
Carstairs says we need to face the reality that 100 per cent of people die. She says it's essential to provide more settings where patients can be comfortable and surrounded by family at the end of life. Where care can do more than treat illness -- it makes it easier to write a happy ending to a life story.
Lindsay Jolivet is a graduate from Carleton University's Master of Journalism program. She is an intern at EvidenceNetwork.ca and her work as appeared in the Montreal Gazette and on CBC radio.
Check out an audio version of this article here.