For the dedicated staff in the palliative care unit of The Salvation Army’s Toronto Grace Hospital, the focus is on living.
“The emphasis is on the patients’ priorities,” explains Deborah Randall-Wood, Patient Care Manager of the program. “They have to be what the patient determines them to be.”
As an example, for one patient it was the ability to play bridge once a week. “We were focused on enabling him to meet that goal,” says Deborah, an 18-year veteran of palliative care whose previous experience includes serving as Executive Director of Toronto’s Casey House Hospice.
“His care was organized so he was ready to go out and play bridge when he was still able to do that. As his illness progressed, we brought in a card table and set it up in the lounge so that he could continue to play bridge with his friends,” she recalls.
“It was so much more than playing cards. It was interacting with friends he’d interacted with for years and his ability to control some aspects of his life. He was still a bridge player,” she says. “That was important to him and, very close to the end, he was still able to play bridge.”
Such specialized treatment requires the caring expertise of a highly trained team of staff and volunteers in the 19-bed unit. Grace’s palliative care unit was Ontario’s first, founded in 1979. It also includes a community home care program. The interdisciplinary team includes RNs, RPNs, health-care aides, an administrative assistant, ward clerk, social worker and spiritual care leader and physicians. There are also a variety of therapists available to provide care and consultation and community physicians who provide additional on call support.
They recognize that care for each of the 19 people being treated on the unit is slightly different. There is common ground in the team’s approach to system management, how they talk to people and in welcoming families into the circle of care. It is a holistic approach that includes the families whenever the patients desire this participation.
She emphasizes that, “we don’t pretend that death isn’t happening. As we’re focusing on the living, we’re very aware that it is living at the end of people’s lives. Walking the line-being able to support and enhance the living at the same time you are recognizing and honoring the dying, that’s where the skill, talent and experience comes in. A lot of our staff and volunteers have been here for a long time and they are able to teach others how to do that.”
The number of palliative care admissions at Grace approaches 200 each year and the average length of stay is approximately 26 days. Admissions come from other hospitals such as University Health Network, St. Joseph’s Health Centre and from the community. A common referral form is available to all social workers, hospital clinicians and community health providers. Grace also offers home care for illnesses requiring palliation. The program allows many to stay at home during this most critical period of their lives.
The patients and the staff are as diverse as the city the hospital serves. “We are a pretty good mirror of Toronto’s culture,” says Deborah. “Our patients are from many different cultural, social, religious and spiritual backgrounds.”
She adds that the rewards for staff and volunteers working on the unit are palpable. Everything they do has a clarity, intensity and intimacy that is unique to that kind of environment. At the end of the day, they’ve made an impact on the lives of people with only a short time left.
They are also sharing the burden with the patients’ families. “Families drop in on their way to the lounge or the kitchen and say how grateful they are for the staff and volunteers and the relief they feel, knowing the person they love is being cared for here,” Deborah says. “It’s wonderful to be part of that.”
She repeats that the focus is on living and providing what patients need to live as well as possible in this very difficult time of their lives.
“Ours is a hospital and unit that is very mission-driven,” Deborah says. “Our mission is to provide the best possible care that we can to people who need chronic and palliative care. Anything else takes second place. We listen to our patients and we’re willing to change.”For further information on Toronto Grace Hospital’s Palliative Care Program please contact Deborah Randall Wood at 416-925-2251, ext 263.