A new study published this week by the Institute for Clinical Evaluation Sciences (ICES) reveals that the majority of Ontario residents would prefer to die at home. Despite this, most (almost 70%) die in long-term care facilities or hospitals. Results of this new study can help inform policy and health care planning at a time where a large proportion of the province’s population is rapidly aging, and add to the ongoing debate around end of life care in Ontario.
The study reviewed more than 260,000 deaths in Ontario between April 2010 and March 2013. It was the largest study of its kind showing the link between home visits made by doctors and where people die. It is intended to assist policy makers and health planners to be able to foresee future needs and highlight areas where care can be optimized.
The study systematically examined both usage and costs across a comprehensive set of healthcare sectors in Ontario, including acute care hospitalizations, physician visits, ER visits, long-term care, home care, and complex continuing care.
The study’s lead author, Dr. Peter Tanuseputro (staff physician in the palliative care division at the Ottawa Hospital Research Institute, scientist at ICES, and researcher at the Bruyère Research Institute), notes that his research has shown that people who receive physician visits at home in their last year of life have their risk of dying in hospital reduced by half. He suggests that Ontario needs a structured palliative care strategy to ensure that people have the choice to die at home. Dr. Tanuseputro and his team found that currently:
Most people would be able to die at home if they had the supports in place to make that happen. Unfortunately in most areas across Canada, it’s quite arbitrary who gets palliative care in the home, depending on factors like if your family doctor does home visits, what neighborhood you live in, and what you’re dying of. Canada remains in the back of the pack in developed nations in terms of the percentage who die in hospital.
The study shows that about 38% of physicians in Ontario deliver palliative care, and only a small amount of those doctors offer home visits. Only one in five palliative care “encounters” occur in a patient’s home. Previous studies by Dr. Tanuseputro and his team indicate that patients with certain diagnoses, such as cancer, and those who live in wealthier neighbourhoods tend to have a higher chance of getting a home visit from a physician.
Dr. Tanuseputro and his team noted that the study’s results can improve understanding of end of life health-care use. The study highlights, for example, the proportion of the population that used long-term care of home care near the end of life, versus those who were admitted to hospital. This can, in turn, be used to inform discussions about end-of-life care here in Ontario. From a cost perspective, the study identifies those sectors which may be important to target for policymakers and health-care planners. The study notes that further research is needed into what type of care is appropriate or absent, particularly in the last four months of life (during which time there are rising acute care costs).
This research provides interesting feedback during a time when governments and policymakers are working to address the reality of what the study has called “the baby boomer cohort effect coupled with an extension of life expectancy” and as the government has been called upon to improve end of life health care for Canadians.
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