Transition to close palliative care unit already undwerway

By Gillian Slade on November 24, 2017.

gslade@medicinehatnews.com  @MHNGillianSlade

The transition process for closing ward Six West at Medicine Hat Regional Hospital, which includes the palliative care unit, has already begun.

Although the official closing of this ward will only take place at the end of December you can’t go from a full ward to nothing overnight, says Alberta Health Services.

“We will start closing a few beds as available and we have done a few already,” said Brenda Ashman, director for critical care medicine, AHS south zone.

Some staff will be transitioning from the middle of December, said Ashman.

At the end of October the News revealed AHS had decided to close ward Six West, which includes up to 12 palliative care beds and about 30 beds mainly occupied by seniors waiting for placement in the community, often referred to as alternative living care beds. AHS said about 55 staff are affected but are all being offered alternative placements.

The decision to close the ward was based on only 50 per cent capacity of the hospital palliative care beds and at Carmel Hospice in St. Joseph’s. Only having Carmel Hospice, operated by Covenant Health, will mean better utilization of beds.

Additional resources will be given to Covenant Health to enhance the hospice program and perhaps add staff.

“There has been conversation and a budget proposed to St.Joseph’s so they are just working through that process to see what Covenant really feels they can do with those budget dollars,” said Ashman noting the additional funding will be in place by the end of December.

Ryan Wiest, site administrator Carmel Hospice, told the News Thursday it is too early to reveal what enhancements are likely to be made. More will be revealed early in the new year.

How someone is transitioned to palliative care and the hospice is not going to be any different than how it has been done in the past. Patients have always been given the option, said Ashman.

“The process shouldn’t be any different,” said Dr. Vince DiNinno, associate medical director for AHS south zone.

Some palliative care patients may still be admitted to acute care at Medicine Hat Regional Hospital (MHRH) if they need hydration, some investigation, or a blood transfusion that is typical of acute care, said DiNinno. Admitting them to hospital will be because they need acute care not because they are palliative.

The broad definition of palliative care acknowledges several phases, said DiNinno. In the first phase you are not expected to die within the next couple of years, and comfort care includes treatment for infections. Toward the end of life a hospice becomes more appropriate.

“At that point we are dealing with comfort measures only,” said DiNinno.

One definition has been that for “hospice” care you are probably in the last six months of life, which can be difficult to predict, he said.

“We may want to revisit that at this point in time,” said DiNinno.

Palliative care is not in anyway part of Medical Assistance in Dying (MAID), said DiNinno.

If however, someone in the hospice requests and meets the criteria for MAID the person will be transferred to MHRH as Covenant Health has had a policy of not providing a venue for this. The necessary assessments for MAID, however, will be allowed to take place at the hospice.

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