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Contributors and stakeholders shared a diversity of opinions and brought insight into hidden issues. For these perspectives, we are very grateful. The following document is a reflection of those insights and opinions. Finally, this Framework would not have been possible without the close collaboration between the contributors and the End-of-Life Care Unit. The Framework on Palliative Care in Canada is the result of shared values and perspectives. Appendix A contains a list of the main groups and individuals that contributed to the development of this document.

Many Canadians find it difficult to discuss death, dying and end-of-life care with their loved ones and health care providers. We tend to avoid these conversations out of fear and pain. Yet, these topics are important to the well-being of dying people and their families. Encouraging Canadians to have honest and informed conversations about death and end-of-life planning can alleviate stress, anxiety and help to ensure that Canadians have the death that they wish. Over time, our experience of death and dying has evolved alongside changing causes of death, care and supports, and cultural and social customs.

The provision of palliative care has also evolved as a practice that seeks to relieve suffering and improve the quality of living and dying for Canadians and their families. However, we know we have more to do to improve person-centred care and equitable access, so that every Canadian has the best possible quality of life right up to the end of their lives. Over the course of the summer of , officials from Health Canada heard many stories of dedication and commitment about people living with life-limiting illness, caregivers, volunteers, and health care providers.

There were, however, also stories pointing to significant gaps in awareness and understanding of, and access to, palliative care across Canada. The message from these conversations was clear: the wishes and needs of Canadians nearing the end of life must be at the centre of our approaches to care. It is critical that their cultural values and personal preferences be voiced, understood and respected when discussing care plans and treatment options.

This message inspired and influenced the Framework on Palliative Care in Canada.

Supporting clients’ palliative and end of life care | Homeless Palliative Care Toolkit

Together we can accomplish much by exemplifying compassion, learning from each other, and working collaboratively. It will take a concerted effort from all of us to continue to advance palliative care for Canadians. I invite all those who have a role to play to join in implementing the findings of this Framework. In late , the Act providing for the development of a framework on palliative care in Canada was passed by Parliament with all-party support.

During the spring and summer of , Health Canada consulted with provincial and territorial governments, other federal departments, and national stakeholders, as well as people living with life-limiting illness, caregivers and Canadians. The findings from that consultation, as well as the requirements outlined in the Act, provided the foundation for the Framework on Palliative Care in Canada.

In Part I, the Framework provides an overview of palliative care, setting out the World Health Organization's definition in the Canadian context. The Framework describes how palliative care is provided in Canada, and the roles and responsibilities of the numerous individuals and organizations involved. It lays out the purpose of the Framework as providing a structure and an impetus for collective action to address gaps in access and quality of palliative care across Canada.

It also provides a brief description of the consultative process. Part II, the heart of the Framework, sets out the collective vision for palliative care in Canada: that all Canadians with life-limiting illness live well until the end of life. Key to this vision is a set of Guiding Principles, developed in collaboration with participants of the consultative process. These principles reflect the Canadian context and are considered fundamental to the provision of high-quality palliative care in Canada.

In recognition of the dynamic state of palliative care in Canada, and its multiple players, this section provides a Blueprint to help shape planning, decision making, and organizational change within the current context. It identifies existing efforts and best practices, and sets out goals and a range of priorities for short, medium and long term action to improve each of the four priority areas:. In this section, the Framework also lays out how we might recognize success as collective progress is made.

In conclusion, Part III outlines implementation and next steps, proposing a single focal-point to advance the state of palliative care.

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It concludes with the recognition that advancement of the Framework will require the collective action of parties at all levels, as well as the flexibility to evolve and respond to new ideas and emerging needs over time. The term "palliative care" emerged in Canada in the mid's, initially as a medical specialty serving primarily cancer patients in hospitals. However, since then, the scope of palliative care has expanded to include all people living with life-limiting illness. With an aging population, demand for palliative care, delivered by a range of providers, has grown. Palliative care is an approach that aims to reduce suffering and improve the quality of life for people who are living with life-limiting illness through the provision of:.

Palliative care should be person- and family Footnote 1 -centred. This refers to an approach to care that places the person receiving care, and their family, at the centre of decision making. It places their values and wishes at the forefront of treatment considerations. In person- and family-centred care, the voices of people living with life-limiting illness and their families are solicited and respected. Palliative care can be provided in conjunction with other treatment plans, and is offered in a range of settings by a variety of health care providers, including but not limited to: doctors, nurses, nurse practitioners, pharmacists, social workers, occupational therapists, speech therapists, and spiritual counsellors.

Footnote 2 Recognizing that the WHO definition is meant for a global audience, the Government of Canada, in consultation with a wide range of stakeholders, developed a set of Guiding Principles. These principles are defined in Part II of the Framework, and allow for the definition of palliative care to be adapted to the Canadian context. Palliative care is an approach that improves the quality of life of persons and their families facing the problem associated with life-limiting illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

Palliative care:. While the provision of palliative care has improved over the years, a number of reports Footnote 4 have identified ongoing gaps in access and quality of palliative care across Canada. While family and friends provide the majority of care for those who are aging or ill, providing such care can create physical, emotional, and financial pressures. One in three caregivers reports distress and burnout. Footnote 5. Changing expectations for person-centred care: A growing number of Canadians expect to have a more active role in decision making about their care, including treatment choices and care settings.

Gaps in professional training: Few health care providers in Canada specialize in or practice primarily in palliative care. Canadian doctors and nurses report varying levels of training for and comfort in providing palliative care Footnote 6. In order to build broader capacity, there are increasing expectations on all health care providers to know how to deliver basic palliative care services. This translates into increased pressure on curriculum development, and education and training methods targeting those whose primary practice is not palliative care.

Increased public discussion about end-of-life care and decisions: On June 17, , the Government of Canada passed legislation to allow for medical assistance in dying to be provided to eligible Canadians Footnote 7. Public discussion around this issue included significant focus on the importance of Canadians having access to a range of care options at the end of life, including palliative care.

Further, it commits Parliament to examining the state of palliative care in Canada five years after the coming into force of the MAID law. To address these changes, governments at all levels, health care providers, stakeholders, caregivers, and communities must work together. The following section describes who is responsible for palliative care in Canada. There is strong evidence that palliative care is beneficial in reducing much of this suffering in patients, as well as psychosocial and spiritual or existential distress in families.

There are many parties involved in the development, planning and delivery of palliative care in Canada. These parties range from the funders of services by governments and foundations, the planners and coordinators of services in provincial, territorial or sometimes regional and local health departments; researchers and data collection officers who consider all of the complex issues related to palliative care and how to capture information in order to make informed policy and program decisions.

On a more personal level, health care providers, either specialist or non-specialist, provide a variety of treatments and pain and symptom management; while counsellors, volunteers and community members provide respite care, spiritual, grief and bereavement supports, among many others.

At the centre of all of these parties, are the people receiving care, their families and caregivers. They too have a role and responsibility in the provision of palliative care in Canada. Over the years, the federal government has taken action to improve access and quality of palliative care Footnote 8. Actions to improve palliative care can draw from and build on best practices from across the country to help identify opportunities and address gaps. More detailed descriptions of provincial and territorial palliative care programs are found in Appendix B, and best practices can be found in Appendix C.

The image is a map of Canada, with each province and territory highlighted in a different colour. Below the map are brief descriptions of palliative care in each province and territory. These are the descriptions:. The delivery model details the palliative approach to care and how it can be applied in practice.

Forms to designate substitute decision makers and for advance directives are available on their website. Yukon also provides a palliative physician resource team for palliative providers to call if they have questions. Advance care planning tools and resources are available on the Yukon government's website, in practitioner offices and through home care.

In Nunavut produced the report "Continuing Care in Nunavut ", which outlined care in the territory. Palliative care services exist on a relatively small scale in Nunavut given the small population size and remoteness of its 25 communities. British Columbia provides palliative care in home, hospice and hospital, through regional health networks. The End-of-Life Care Action plan explains plans for future improvements.

Alberta provides palliative care through Alberta Health Services AHS , depending on the location of care and needs of the patients. Alberta's Palliative and End-of-Life Framework outlines key initiatives for increasing access to and strengthening palliative care programs across the province.

Saskatchewan describes the palliative care delivery as a primarily "home-based mandate", delivered by regional health authorities pending full amalgamation into a province-wide health authority. Advance care planning is legislated by the Substitute Decision Maker Act Each RHA has a palliative care coordinator in place to manage access to palliative care services. CancerCare Manitoba is currently working to encourage advance care planning and goals of care discussions.

Resources for advance care planning are also available online. In Ontario, a broad range of providers deliver palliative and end-of-life services across the continuum of care. Ontario's Ministry of Health and Long-Term Care funds 14 Local Health Integration Networks LHINs , which are responsible for planning, co-ordinating, funding, and monitoring health services, including palliative care, and delivering home and community care services, including residential hospice care. Palliative services are available in Quebec in hospital, home and residential hospice. Quebec has legislated its framework through the Act Respecting End-of-Life Care, which details the organization of end-of-life care and the primacy of patient wishes with respect to medical directives.

An Advance Care Planning form detailing medical directives has been developed and is available online. In April , New Brunswick released a person-centered and integrated services framework for palliative care. The framework mentions five priority areas, including regional health authorities, person-centred care, family inclusion, professional capacity and community capacity. Advance Health Care Directives were introduced in , and are available online.

Palliative care in Prince Edward Island is provided through a single province health authority. PEI has been a leader in the paramedics providing palliative care at home program. An Advance Care Planning interactive website is available online. Palliative care in Nova Scotia is primarily delivered through a single provincial health authority. In , the province released its Palliative Care Strategy, highlighting four pillars that guide the framework: integrated service delivery, accountability, family and caregivers, and capacity building and practice change.

Nova Scotia also has a "Personal Directives Act" and a personal directives booklet for information on advance care planning. Palliative Care in Newfoundland and Labrador is provided primarily through a combination of home care and acute care settings. The province has developed an advance care planning booklet, as well as legislation which gives advance directives legal force.

Newfoundland and Labrador is currently aiming to integrate the palliative approach throughout its health care system. Individuals, families and caregivers are the core stakeholders in any discussion about palliative care. However, Canada also has a number of strong national and regional organizations Footnote 11 with mandates and missions to improve access to palliative care. Many of these organizations are leaders in the field both within Canada and internationally.

See Appendix D for an Overview. Some of the best practices from these organizations are highlighted throughout the Framework and many more are listed in Appendix C. Many of these organizations have worked closely with all levels of government to provide input and guidance on palliative care programs and activities, as well as on the Framework consultations and development.

The Framework can be used by organizations with an interest in palliative care as they develop their policies and programs for the future. According to the Economist Intelligence Unit's Quality of Death Index, Footnote 15 Canada has slipped from 9th to 11th out of 80 countries based on the availability, affordability and quality of palliative care. While the provision of palliative care has improved since its inception in the 's, a number of reports have identified ongoing gaps in access and quality of palliative care across Canada.

Recognizing the dynamic state of palliative care in Canada, the purpose of the Framework is to provide a tool for all parties with a responsibility for palliative care, to help shape decision making, organizational change, and planning within the current context. With the development of a common Framework, the Government of Canada aims to support policy and program decision making to ensure that Canadians are able to access high quality palliative care. A Word about Policy Frameworks… Policy frameworks are multipurpose tools.

Optimizing Quality of Life in Serious Illness: Benefits of Palliative Care Support

They can guide decision making, set future direction, identify important connections, and support the alignment of policies and practices, both inside and outside an organization. In short, policy frameworks are blueprints for something one wants to build, or roadmaps for where one wants to go. In December , Parliament passed into law An Act providing for the development of a framework on palliative care in Canada. Footnote 16 See Appendix E. The Government of Canada recognized the complexity of palliative care, and so, in keeping with a person-centred approach, the consultation process was expanded to include people living with life-limiting illness, families and caregivers, underserviced populations, non-governmental organizations, health care providers, and researchers to help shape the Framework.

In May , the Health Canada launched a broad, multi-pronged consultation process, designed to reach Canadians, health care providers, caregivers, people living with life-limiting illness, and subject matter experts. The process used multiple platforms and networks in order to reach out across the country:. Representatives of Canada's Indigenous peoples have been clear about the importance of culturally-appropriate palliative care for their communities. The Framework reflects a collective vision for palliative care aiming to ensure Canadians have the best possible quality of life, right up to the end of life.

All Canadians are touched by end-of-life care issues, either for themselves, or for someone they know.

Background

Our vision is for all Canadians with life-limiting illness to experience the highest attainable quality of life until the end of life. In the spirit of bringing greater clarity and consistency to conversations about palliative care in Canada, the Framework sets out ten Guiding Principles. They should be considered and reflected in program and policy design and delivery. Palliative care is respectful of, and responsive to, the needs, preferences and values of the person receiving care, their family, and other caregivers. It is facilitated by good communication.

Individuals and families have personal preferences and varying levels of comfort in discussing, and planning for the dying process and death itself. A cultural shift in how we talk about death and dying is required to facilitate acceptance and understanding of what palliative care is and how it can positively impact people's lives. The integration of palliative care at the early stages of life-limiting illness facilitates this culture shift by supporting meaningful discussions among those affected, their families and caregivers regarding care that is consistent with their values and preferences.

Given their unique role in supporting individuals, family and other caregivers are respected by the health care team for their knowledge of the care preferences and needs of the person with a life-limiting illness. Palliative care encompasses the health and well-being of caregivers, and includes grief and bereavement support. Palliative care is integrated with other forms of care such as chronic illness management throughout the care trajectory, and across providers.

Services are provided in a range of settings such as homes, long-term and residential care, hospices, hospitals, homeless shelters, community centres, and prisons. It is holistic, addressing a person's and their family's full range of needs - physical, psychosocial, spiritual, and practical - at all stages of a chronic progressive illness. It requires standardized or shared data systems in order to coordinate care during transitions from one setting or provider, to another.

Canadians with a life-limiting illness have equitable access to palliative care, regardless of the setting of care or personal characteristics, including, but not limited to their:. A palliative approach to care requires adaptability, flexibility and humility on the part of the health care provider and the health system, in order to reach a shared understanding of the needs of each individual. Canada is a diverse country. Our population consists of myriad ethnic backgrounds, languages, cultures and lifestyles.

While diversity is a natural characteristic of every society, being inclusive is a choice. Just as we Canadians pride ourselves on embracing our diversity and on being inclusive, palliative care recognizes Canada's diversity and encourages the adoption of inclusiveness, paying special attention to ensure that underserviced populations are taken into consideration as we aspire to universal access to palliative care.

Palliative care helps identify and respond to people's physical, psychosocial, emotional and spiritual needs early, particularly when coupled with advance care planning. It can also avoid costly, ineffective measures that do not contribute to improving an individual's quality of life. The appropriate use of technology, community-engagement models, and public education are integral to delivering palliative care.

Program and policy decisions on palliative care are informed by evidence and relevant data. As such, research and data collection must be adequately supported to establish and validate an evidence base necessary for policy decisions and program planning. Palliative care reduces suffering and improves quality of life for people with life-limiting illness and their families.

Palliative care is appropriate for persons of all ages, with any life-limiting illness, and at any point in the illness trajectory. It includes support for family and other caregivers, including in their grief and bereavement. A palliative approach to care may be offered by a broad range of care providers and volunteers, in any setting. The delivery of palliative care in Canada is the shared responsibility of all Canadians. This Framework encourages everyone, in their respective capacity, to work together to achieve the goals set out in this Framework on Palliative Care in Canada.

They are designed to guide short term 1 - 2 years , medium term 2 - 5 years and long term 5 - 10 years action to reach a shared vision on palliative care. Given the complex, cross-sectoral nature of palliative care, no one party can be responsible for all of these priorities. They belong to all those involved with palliative care, including persons living with life-limiting illness, caregivers, all levels of government, communities, not-for-profit organizations, health care providers, the voluntary sector, and all Canadians.

A robust and skilled health workforce is essential to future sustainable palliative care delivery. There are many opportunities to improve ways in which health care providers, caregivers, and volunteers are trained, with some promising practices that can be expanded to meet this need. The following priorities refer to training and education programs for both health care professionals and informal care providers caregivers, volunteers.

Nursing Curriculum Resources Canadian Association of Schools of Nursing - Palliative and end-of life care teaching and learning resources for nurse educators. Nova Scotia Palliative Care Competency Framework Shared and discipline-specific competencies for health professionals and volunteers who care for people with life-limiting conditions and their families in all settings of care.

Just knowing about options is often the biggest barrier to receiving help… Awareness of bereavement supports is also really important. While many innovative supports exist across Canada, there is often a lack of awareness about them, and how to tap into them. Raising public awareness of these resources and the benefits of palliative care more generally would benefit palliative care providers, as well as their patients, clients, and other elements of the health care system. Improved understanding of existing programs helps to identify gaps and spur innovation to address them.

Developed by a team of national and international grief experts together with people who have experienced significant loss. Caregiver Compass Tips and tools to help caregivers manage their responsibilities, including communication and decision making, navigating the health care system, financial and legal matters. Sustained research and data collection is vital for long-term and continuous improvement in palliative care.

Evidence is needed to address knowledge gaps, overcome current challenges and drive innovation towards effective practices. Ultimately, improved data collection and research will enhance the quality of life for all Canadians living with life-limiting illness and their families and caregivers, by providing much-needed data and evidence to drive improvements and support new models and approaches to care.

When the state of publicly funded palliative care in Canada is understood, health system planners can identify service gaps and develop strategies for improving care. Canadian Institute for Health Information CIHI's report, Access to Palliative Care in Canada provides the baseline for what we know about palliative care service provision, across settings, in the last year of life.

Pan-Canadian Framework for Palliative and End-of-Life Care Research Canadian Cancer Research Alliance, This framework aims to build capacity to address unmet needs and broaden the scope of palliative care research for the future. Improving End-of-Life Care and Advance Care Planning The Canadian Frailty Network is supporting a program of research on end-of-life care planning and decision making, to improve the care of older adults living with frailty, their families and caregivers.

A consistent challenge to accessing quality palliative care stems from the lack of specialized palliative care providers in Canada. However, not all people receiving palliative care require highly specialized care. In fact the majority of them can have high quality palliative care provided by their caregivers, family doctors, nurses, nurse practitioners, social workers, personal support workers, volunteers, and members of the community.

The following figure is a conceptual model of level of need of care for a person living with life-limiting illness, aligned against health care provider involvement. The base of the triangle represents the majority of individuals receiving palliative care, who require minimal specialist care, and whose symptoms can be managed effectively in home and community settings by their primary health care teams, caregivers and through community supports. This majority can benefit from a "palliative approach to care", which integrates core elements of palliative care into the care provided by non-specialists.

Homeless Palliative Care Toolkit

As the complexity of needs increases, the health care providers become more specialized, but the number of people requiring this level of care is lower. This minority of people at the top of the triangle require the skills of palliative care specialists, often provided in the hospital or hospice setting. On the far left is a vertical arrow pointing upward, divided from bottom to top, in three equal thirds. To the right of the arrow, is a triangle pointing upward, divided from bottom to top, in equal thirds.

To the right of the triangle is a set of three horizontal arrows pointing to the right, each starting from the middle of each of the thirds of the triangle. To the right of the three arrows is a set of three rings of different sizes. The largest circle is at the bottom, the middle circle is in the center and the smallest circle is at the top.

Sixth, at the base of the diagram are two miniature circles, red and one blue. The red circle indicates the predominant use of palliative care specialists. The blue circle indicates the predominant use of other health professionals. To the far left, the arrow is labeled on the right with the words: "Increasing Complexity of Palliative Care Needs".

The arrow is divided into three colours, red to the upper third, royal blue to the central third and dark blue to the lower third. The triangle, to the right of the arrow, is divided into three colours, pale blue in the upper third, royal blue in the central third and dark blue in the lower third. The three arrows, to the right of the triangle, are pale blue with writing in them. The top arrow is labeled "Complex and Persistent". The center arrow is labeled "Intermediate and variable". The bottom arrow is labeled "Straightforward and predictable".

Each of the three circles to the right of the arrows are divided into two colours, red to the upper portion, royal blue to the lower portion. They differ in colouring with the upper circle being mostly red, the middle being almost equally red and blue, and the bottom circle being mostly blue - representing the intensity of specialist care compared to other health professionals. Finally the rectangle above the triangle is black.

Intermediate and variable care requires an equal distribution of specialized palliative care providers and other health professionals. This model Footnote 17 requires non-specialist health care providers to have basic palliative care competencies and the ability to access specialists for advice, consultation, and referral when necessary. This aligns with the models of care already provided in Canada where primary care providers and specialists work together in areas such as cardiac or cancer care.

Shoring up these skills among non-specialist care providers would allow for more Canadians to have access to palliative care at the primary care level. This approach also allows for more active involvement of community, family and caregivers. Combining this model with movements such as Compassionate Communities, would be a significant step in providing full coverage and access to supports to improve quality of life through to the end of life.

Furthermore, it provides for a more effective use of health resources, and allows the person living with a life-limiting illness to remain in the setting of their choice for as long as possible e. Access issues are complex and occur in all settings, whether in dense urban settings or rural and remote regions of Canada. Many Canadians have difficulty accessing high quality palliative care due to system capacity issues, lack of understanding of the benefits of palliative care among health care professionals and the public, geography and demographic diversity e.

All of the priorities identified above will have a positive impact on underserviced populations Footnote 20 ; however, the following are more specific to their unique needs:. Palliative Education and Care for the Homeless PEACH PEACH aims to meet the needs of homeless and vulnerably-housed patients with life-limiting illness via a "trailblazing" mobile unit, providing attentive care on the streets, in shelters, and with community-based services. A similar program was implemented in Alberta. With the adoption of the actions laid out in the priority areas, and concerted effort at all levels, we will see improvements in access to palliative care across Canada.

The following table outlines some of the shifts in policy and programming we can bring about through this work:. This Blueprint is a tool that can be used to find common understanding and focus for policy makers and planners in the Canadian palliative care context. Vision: All Canadians with life-limiting illness live well until the end of life. Palliative Care Definition: An approach to care that improves the quality of life of people of all ages who are facing problems associated with life-limiting illness, and their families. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.

Moving forward, the federal government will collaborate with interested parties to develop a plan to implement those elements of the Framework that fall under federal responsibility. Although the timeframe of the Framework development process did not allow for a thorough engagement process with Indigenous peoples around palliative care, ongoing work will include discussions between Health Canada and National Indigenous Organizations about Indigenous-led engagement processes toward the development of a distinctions-based palliative care framework for Indigenous Peoples.

The implementation plan will also include the creation of an Office of Palliative Care, which is laid out in more detail below. In order to support this Minister and coordinate efforts on the Strategy, Health Canada established a time-limited Secretariat. While the Secretariat ended in , federal initiatives on palliative care continued.

Given the inter-jurisdictional, cross-sectoral nature of the issues identified in the development of the Framework, a single focal point is needed to help connect and facilitate activities at various levels seeking to improve access to palliative care in Canada. Health Canada will continue to work with jurisdictions and key stakeholders to more clearly define the OPC's roles and responsibilities, and will consider existing models and networks for format and function to leverage resources and avoid duplication.

Creation of the OPC will coincide with the development of the Framework implementation plan. This Framework outlines the vision, goals and priorities expressed by consultation participants to improve palliative care in Canada. The priorities are complex and require the collaboration of all interested parties, including persons with life-limiting illness and caregivers, academia, health care delivery organizations, health professional groups, community organizations, and all levels of government - we all have a role to play.

Framework on Palliative Care in Canada

Throughout Health Canada's consultations, participants not only shared their lived-experiences and wisdom, but also their innovative ideas and leadership. The resulting Framework is a tool that any level of government or health care or academic organization can use for decision making, to guide organizational change, to inform health care training and education, and for workforce planning.

The Framework can be used by people living with a life-limiting illness and their families to facilitate end-of-life discussions with their primary care teams, to learn about best practices, and to explore what supports exist where they live. Health care systems are not static - they evolve to respond to pressures and meet the needs of citizens. This Framework will also continue to evolve over time and will be revisited by those who contributed to it, in order to ensure it reflects the current state of palliative care in Canada; roles will continue to be clarified and definitions will evolve with increased data collection and research.

This is a living document - designed to be a starting place for continuous open dialogue as we address challenges and culture shifts together. There is no national palliative care program or strategy in Canada, but rather many parties with distinctive responsibilities related to palliative care. Through our consultations, we were able to create the following snapshot of the current palliative care policies and programs that exist to serve Canadians - these are stand-alone from the Framework on Palliative Care in Canada.

Various departments, agencies and organizations have some degree of responsibility over supports, programs or services related to palliative care. These include the following:. CIHR is the major federal agency responsible for funding health and medical research in Canada. CSC is responsible for the health and well-being of inmates in 43 correctional institutions across five regions. Fifty-seven health centres provide pharmacy, hospital and mental health services to inmates.

CSC has Palliative Care Guidelines currently being updated to address the need for more timely response to the palliative needs of inmates, and to reflect the new realities of inmate patients' rights to access medical assistance in dying. Correctional facilities are not always set up to provide all of the types of palliative care supports required. Therefore, the Office of the Correctional Investigator recommends that CSC works with the Parole Board to ensure that palliative or terminally ill inmates seek Section "parole by exception" to allow them to spend as much time in the community among family and friends as early as possible, provided they do not pose a risk to society.

CSC has recently implemented information-sharing systems to facilitate this process. Challenges with this new approach include limited capacity within community hospices, where they exist. CSC is also looking at ways to increase palliative care competencies for employees providing health care services to inmate patients. The Employment Insurance EI Compassionate Care Benefits provides up to 26 weeks of income support and job security to eligible individuals caring for a family member with a serious medical condition and a significant risk of death.

Benefits can be shared between family members, either at the same time or separately. The EI Family Caregiver Benefit , for adults provides up to 15 weeks of benefits to individuals who are temporarily away from work to provide care or support for a critically ill or injured adult family member, 18 years of age or older.

Eligibility includes immediate and extended family members and individuals that the critically ill adult considers to be like family. The EI Family Caregiver benefit for children provides up to 35 weeks of benefits to any EI-eligible family member who is providing care or support to a critically ill child under the age of In order to be eligible for these EI Caregiver benefits, an individual must have accumulated insured hours of work in the 52 weeks before the start of their claim, or since the start of their last claim, whichever is shorter, or earned the minimum self-employment income and opted to pay EI premiums.

The Canada Health Act ensures that all eligible Canadian residents have reasonable access to medically-necessary hospital and physician services without paying out-of-pocket costs. Responsibility for health care services is shared between provincial and territorial governments and the federal government. Six billion dollars are dedicated to increasing the availability of home and palliative care.


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Planning for the Caregiver. Palliative Care in Cancer. On This Page What is palliative care? Who gives palliative care? What issues are addressed in palliative care? When is palliative care used in cancer care? How does a person access palliative care? What is the difference between palliative care and hospice? Who pays for palliative care? Is there any research that shows palliative care is beneficial? Does NCI support palliative care research? What is palliative care? A palliative care specialist will take the following issues into account for each patient: Physical.

Common physical symptoms include pain, fatigue, loss of appetite, nausea, vomiting, shortness of breath, and insomnia. Emotional and coping. Palliative care specialists can provide resources to help patients and families deal with the emotions that come with a cancer diagnosis and cancer treatment. Depression, anxiety, and fear are only a few of the concerns that can be addressed through palliative care.

With a cancer diagnosis, patients and families often look more deeply for meaning in their lives. Some find the disease brings them closer to their faith or spiritual beliefs, whereas others struggle to understand why cancer happened to them. An expert in palliative care can help people explore their beliefs and values so that they can find a sense of peace or reach a point of acceptance that is appropriate for their situation.

Caregiver needs. Family members are an important part of cancer care. Like the patient, they have changing needs. Many find it hard to care for a sick relative while trying to handle other obligations, such as work, household duties, and caring for other family members.