Statement made on 15 February 2011 by Senator Terry Mercer
Hon. Terry M. Mercer:
Honourable senators, it is again a pleasure to rise and speak today on an inquiry introduced by Senator Carstairs, this time on palliative care. Senator Carstairs is a true leader on issues involving aging and end-of-life care, and I would like to thank her for her years of dedication to studying these issues and keeping them at the forefront of debate.
As we all know, Senator Carstairs' reports on palliative care and aging were numerous. I will list them: Of Life and Death in 1995; Quality End-of-Life Care: The Right of Every Canadian in 2000; Still Not There — Quality End-of-Life Care: A Progress Report, 2005; Canada's Aging Population: Seizing The Opportunity in 2009; and, most recently, Raising the Bar: A Roadmap for the Future of Palliative Care in Canada in 2010.
Even with all these reports and research, we are still not prepared for the amount of coordination that is required to provide quality palliative care in this country, but we are getting there.
Honourable senators, palliative care is really not just about ease and care in the last hours of someone's life. It involves, or rather should involve, a process that starts at diagnosis through to death, and then afterwards helps families deal with the entire process. How we get to perfecting that process is what is at issue.
While the federal government has numerous responsibilities when it comes to the health of Canadians, it is the provinces and territories that are responsible for health care to Canadians. That is an important distinction to be made. In order to provide the delivery of good quality health care, all levels of government must work together with all stakeholders, including doctors, nurses, medical associations, hospitals, and the list goes on.
Still Not There — Quality End-of-Life Care: A Progress Report from 2005 examined progress on implementing the recommendations made in the reports tabled in 1995 and 2000. Along with the recommendations for a renewed national strategy for palliative care, the report also recommended improvements to the compassionate care benefit under Employment Insurance; increased education and training; and the creation of a public information program on services available, legal rights and care for the dying.
Important strides were made since 2000 in these areas, but the number of Canadians who had access to quality palliative care was still not good enough.
Honourable senators, in October 2009, the Canadian Institutes of Health Research, Institute of Cancer Research, released a report entitled Palliative and End-of-Life Care Initiative: Impact Assessment. This report engaged 18 partners in health care and delivery, from Health Canada to the National Ovarian Cancer Association, to the Heart and Stroke Foundation of Canada, and many others.
An interesting point from this report was that it built upon clinical research capacity and greatly increased the quantity and quality of research on palliative care. According to the report, this research did and still continues to produce results that are being integrated into practice guidelines, health professionals' training and policy discussions.
There were some interesting points from the CIHR report.
Both quantity and quality of care were major problems: Too little care for many who could benefit from palliative care but did not receive it and too much care in the form of heroic treatment for those who preferred a less aggressive course.
The statistics tell us that in 10 to 15 years, we will have 20 per cent more deaths and 20 per cent fewer health care providers.
That is a recipe for disaster.
All coordinated national strategies have therefore advocated the need to build research capacity, particularly among clinicians, and to establish palliative care as a respectable new interdisciplinary — or better, trans-disciplinary — research field.
These are not new statistics or new ideas that we are hearing about for the first time. As with the reports that Senator Carstairs has spearheaded, it seems that better research, better training and more integration of best practices are the way to approach it, and we are getting there.
However, are we progressing quickly enough? The newest report, Raising the Bar: A Roadmap for the Future of Palliative Care in Canada, tabled in 2010, makes 17 further recommendations to serve as a guide for building a better palliative care system in this country. It also builds upon the previous reports that have been tabled in the Senate.
The report identifies five things we can do to help create and improve access to quality palliative care: a culture of care, building capacity, support for caregivers, integration of services, and leadership.
I will not comment heavily on the report, as Senator Carstairs has already done so better than I could have. However, I will say that with any discipline within the health care system, a multi-jurisdictional approach is required so that everyone is working together and not duplicating or deleting services. Palliative care is no different.
Honourable senators, there are many things we can still do to increase the quality of palliative care in this country. As the report identifies, the responsibility lies with governments at the federal, provincial and territorial levels, but it also lies within the community, including community organizations and health care providers. It lies with the families of loved ones who need care and also with the volunteers who play a pivotal role in good quality palliative care services. However, all of these groups need to work together to make it better. Leadership is required to bring them together and to streamline the process.
Therefore, the federal government should re-establish the Canadian Strategy on Palliative and End-of-Life Care and it would do well to listen to the other recommendations of the report, including establishing a Canada Pension Plan dropout provision for caregivers, similar to that for parents who stay home with new children, and revamping the compassionate care benefit program under Employment Insurance to improve the application process and to lengthen the period of support from 6 to 26 weeks.
When I spoke last week about the impact dementia is having and will have on society, I mentioned the Liberal Party plan to invest $1 billion annually in a new family care plan to help reduce the pressures faced by Canadian families with ill or dying loved ones. The Liberal plan will introduce a new six-month family care Employment Insurance benefit and will offer a new family care tax benefit that would help caregivers compensate for the cost of providing care to a family member at home, whether they are suffering from an illness or indeed facing death. Therefore, someone is actually listening to what these reports are saying.
The report also encourages the provincial and territorial governments to foster interprovincial and territorial cooperation, to work in partnership with the federal government, and to ensure palliative care services are covered under all provincial and territorial insurance plans.
We can have a world-class system of palliative care in this country, but we all must work together. If we do not, the consequences could be quite alarming.
In a recent story from the CBC this past month, the daughter of an elderly dementia patient in British Columbia revealed that her mother was given a potentially dangerous drug, which was not approved for treating her condition. Records show the drug eventually contributed to her having a major seizure. The 83-year-old mother died in November of natural causes, however.
The CBC also reported that a 92-year-old resident of a seniors' home in Halifax died earlier this month, one month after being pushed to the ground and even beaten by another resident. This is the second incident involving abuse of a senior reported in this particular seniors' home.
Honourable senators, as you can see, without proper systems in place, situations can arise like because of inadequate services and quick fixes. Whether there is not enough properly trained staff to deal with the situation, or not enough funding to enact a proper care program, we cannot and should not allow this to happen. Only through an integrated approach, stable and direct funding, and sharing of best practices can we build the best systems for palliative care.
As Senator Carstairs stated, 90 per cent of Canadians who die can benefit from palliative care, yet just over 30 per cent of Canadians are presently receiving palliative care services in Canada. We all know that we are going to die some day. Would it not be comforting to know that it can be in the best way possible for yourself or for your family and friends you leave behind?
Thank you, honourable senators.