um anit o ba.

ca

http://umanito ba.ca/o utreach/evidencenetwo rk/archives/8693

Half of seniors are dying in hospitals, study

A version of this article was published in the Huffington Post Most seniors say they want to die at home. However, about half of seniors are dying in hospitals, according to recent research by Verena Menec, the Director of the University of Manitobas Centre on Aging. She says many of these patients dont need to die in the hospital. T hey could be dying in more comf ortable settings if we had the services to provide them. But of ten, we dont. Menec, who is also an expert with EvidenceNetwork.ca, says hospital care isnt structured to treat f rail, elderly patients with chronic illnesses. Its very stressf ul to the person who is dying in that setting but it can also be very stressf ul f or the f amily, 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, f rail, conf used. T heyre coming through an emergency department and they die in an emergency department. T heres no f amily, theres that whole bustle of the emergency department, Menec says. I think thats really sad. Dr. Louise Coulombe provides that care. She drives around the city delivering palliative services to patients in their homes. Back at her Ottawa of f ice, the computerized management system calls out the names of patients who are due f or a visit. T he cold, digital voice contrasts with Coulombes description of her very personal interaction with patients. You basically see people in f our dimensions at home. You walk in and immediately you know theyre dif f erent f rom 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 f urther. Peacock could live f rom three months to six months or more. Well here I am. I dont know how long itll be but I dont care. You just live it day by day anyway. You know? Live everything day by day. Hes lived in this house since shortly af ter he returned f rom serving in the Second World War. He still remembers the date he moved in, October thirtieth, nineteen f orty seven. Fif ty-f our years Ive been here. Oh jeez, imagine that. A whole lif e gone. Peacocks wif e, Vera, died here and this is where hed like to stay. So we stayed here and Im 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 f eel that we could conquer death and were learning, in the last f if teen, thirty years that we

cant. And were beginning to see that this is part of lif e. Bef ore it was separated completely and you died in a dark place in a hospital and thats how you did it in this society. Advocates like Sharon Carstairs say the strain on the system will be damaging if we dont change how we deliver health care and soon. Were actually going to go backwards unless we make a signif icant change in the way we deliver care. Carstairs retired f rom Canadas Senate af ter seventeen years advocating f or a bigger f ocus on palliative care. She says we need to reinvent the health care system to avoid debt f rom rising costs. We need more doctors, we need more nurses, we need more health care prof essionals 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, with f ull beds costing the system about a thousand dollars a day in hospital, compared to about half the cost in a hospice. Home care can be more or less expensive depending on the type of care the patient needs. Carstairs says we need to f ace the reality that one hundred percent of people die and providing more settings where patients can be comf ortable and surrounded by f amily at the end of lif e is essential. Where care can do more than treat illness it makes it easier to write a happy ending to a lif e story. Also, listen to the audio podcast of this story. Lindsay Jolivet is a graduate from Carleton Universitys Master of Journalism program. She is an intern at EvidenceNetwork.ca and her work has appeared in the Montreal Gazette and on CBC radio.