Bridgepoint Community Rehab: Providing End-of-Life Care in the Home

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One of the most significant trends currently impacting Bridgepoint Community Rehab staff, and other homecare providers across Canada, is the increased demand for palliative care services in the home.

Recent advancements in several key areas have helped to shape this movement:

  • Technology: Medical equipment essential for end-of-life care has become more portable, and easier to set up in the home.
  • Research: Studies have shown that most palliative patients prefer to be at home, and that their family caregivers wish to care for them. There is also evidence that palliative patients enjoy a better quality of life and experience lower rates of depression when cared for at home.
  • Government: Recognizing the economic and therapeutic benefits of homecare, governments have been developing policies that move away from longer hospital stays and encourage the trend toward community-based care.
  • Education: People are increasingly more aware of their care options and more comfortable with the idea of community-based palliative care.
  • Homecare: The homecare profession has expanded to include different types of treatments and higher skill levels, so providers are better equipped than ever to care for their palliative clients.

Over the last decade, this trend has resulted in the growth of specialized services for people who choose to die at home. “In 1999 the demand for palliative homecare services became so great we decided to partner with Mount Sinai Hospital’s Temmy Letner Centre for Palliative Care and start a formalized program for it,” explains Dipti Purbhoo, Manager of Client Services for the Palliative Care Program at the Toronto Community Care Access Centre (CCAC). “Since we began the palliative care program in 1999, we’ve seen a 7% increase every year in the number of people requesting these services at home. We expect that number will continue to increase.”The Toronto CCAC is one of Bridgepoint Community Rehab’s main referral partners, and changes affecting the former are inevitably felt by the latter. Staff at Bridgepoint Community Rehab are adapting to this growing trend by modifying the treatment they provide to meet the specific needs of palliative clients. Rehabilitation goals are individualized for each client, and focus on maximizing comfort and slowing deterioration of functioning.

Speech-Language Pathologists help clients find new ways to communicate when speaking becomes difficult or impossible, and assist with issues around feeding and swallowing.

Physiotherapists focus on maximizing physical functioning and mobility, maintaining strength, managing pain, positioning and comfort, and preventing pressure sores. Occupational Therapists ensure clients remain as independent as possible in their activities of daily living. Social Workers organize referrals for volunteers and other community resources; help to prepare advance directives, wills and funeral arrangements; and provide counseling to assist clients and families to cope.

One of the biggest adjustments made by homecare therapists is widening the focus of their care to tend to the pressing needs of family caregivers, those who are supporting their loved one at home. (The term ‘family caregiver’ is used here to describe anyone who cares for their loved one at home, regardless of whether they are related).

Even for the most energetic and committed family caregiver, tending to a loved one who is dying is a highly stressful experience. “It’s not unusual to find that the family caregiver is actually more stressed out than the person they are caring for. There are enormous strains placed on them – emotionally, physically and financially,” explains Nancy Latimer, a Social Worker with Bridgepoint Community Rehab.

Flexibility and responsiveness are the most important qualities a homecare provider can offer a family caregiver, according to Speech-Language Pathologist Lesley Grimshaw. “By the end, you’re really working more with the family caregivers than with the client. You need to stay in touch by phone, and be willing to come at a moment’s notice if you’re needed.”Between caring for clients and for family caregivers, homecare providers also have to take the time to care for themselves, to stave off burnout and stress-related conditions. Establishing appropriate boundaries with clients, and maintaining a solid personal life, with relationships and interests outside of work, are crucial priorities in self-care.

Another strategy for self-care is engaging in professional development, learning more about end-of-life care, about grief, and about new procedures and technological advancements in palliative homecare. “Information helps you feel more confident that you are providing the best care possible, so you don’t feel overwhelmed. When you’re confident, clients and their families feel more reassured just by having you there,” says Nancy.

With palliative homecare services still a relatively new trend, formalized avenues for professional development are few and far between. But opportunities are gradually becoming more available to homecare workers, as health care planners and policy-makers recognize that dying with dignity in one’s own home is an important development to watch, and one that is only likely to grow. Bridgepoint Community Rehab staff are well prepared to address the unique and specialized needs of this client population.

Bridgepoint Community Rehab is part of the Bridgepoint Health network of care and services, focused on providing a continuum of care for patients in the Greater Toronto Area who require complex care and complex rehabilitation.