Home-Based Palliative Care

Building Operational Excellence

Assessment and Care Planning

A palliative approach to care focuses on meeting a person’s and family’s complete needs – physical, psychosocial and spiritual – at all stages of a chronic progressive illness. Care can be provided at any time, not just in the last days of life. There are many options to where palliative and​ end of life care can be provided, in the home, hospital, long-term care facility or free-standing hospice.

An important part of home-based palliative care is assessing needs and planning care.

Assessing the strengths, preferences, and needs of adults who are receiving home-based palliative and end-of life care is an important part of home-base palliative care. Health care providers use evidence-informed assessment tools to evaluate pain, identify symptoms and determine how an individual can best be served from home-based palliative approach to care.

Care plans outline the patients’ needs, the types of palliative services they will receive, what member of the care team will provide the services and when. Developed with the individual and their caregiver(s), care plans define the activities, interventions and expected patient outcomes that should occur based on the patient’s assessed needs.

Phase 1. Creating Palliative Care Experience Maps

The CHCA is hosting four workshops across Canada (B.C., AB, ON and PEI) to gain a better understanding of the detailed operational practices in four key priority areas in home-based palliative care:

  • Assessment and care planning
  • Inclusion of advance care plans into care delivery
  • Management of equipment supplies and medication
  • Effective communication strategies and tactics

Participants will create a Palliative Care Experience Map that visually shows the key processes, actions, relationships, communications and decisions that are necessary for assessing the strengths, preferences, and needs of adults who are receiving home-based palliative and how assessed needs are translated into care planning and service delivery.

Following the workshops, the CHCA will conduct an E-Delphi process to gain broader stakeholder input and consensus.  Our goal is to understand the fundamental operational processes, not create one standardized approach.  Each of the four Palliative Experience Maps will form the basis for the next phase of the project – the Call for Innovations in home-based palliative care, that will be launched in mid-August 2018.

Creating a Palliative Care Experience Map

On July 25, stakeholders from BC came together to discuss approaches needed for effective assessment and care planning in home-based palliative care team.

Operational Innovations in Home-Based Palliative Care

Successful innovations featured at the 2018 CHCA Home Care Summits in Charlottetown PEI (Oct 1 & 2) and Vancouver BC (Oct 21 & 22).

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