Hospital

Canada has universal health care, which provides basic health care without user fees. Yet the provinces control health care, and some charge a fee to access the health system. Palliative care is a basic service in all provinces and territories, so there’s no charge for palliative care in a hospital. Provincial and territorial governments usually cover the medications in this situation.

If a person doesn’t need palliative care or acute care in a hospital or institution, then alternatives are considered. If a person’s condition is stable, then care may be better provided elsewhere such as in a hospice, care home, or the person's own home. Home care services provided by the government don’t have a fee. A care home or a hospice likely does charge a fee that usually depends on the facility or the individual's income.

If you’re concerned about the cost of care, some provinces and territories have special programs to cover all or some of the cost of medications for palliative care patients. These may apply to care at home, in a care home or in a hospice. Most of these government programs have criteria, which can be found on palliative care or provincial websites. Your health care team can tell you more about how the health care system works and specific resources in your region.

Several factors determine the best place for providing care to a person with an advanced illness. This type of decision requires a balance between patient and family needs, and the availability of resources to meet those needs.

Patient and family considerations include the following:

• patient and family preference;
• physical ability to manage aspects of care such as hygiene and movement/mobility;
• medical condition and needs such as administering medications and managing symptoms;
• economic, emotional, social, and spiritual needs.

Resources available to meet these needs vary among areas and programs, and may include the following:

• home care services;
• the healthcare team;
• technical resources for symptom management, such as pumps and injections.

When someone wants to be at home, healthcare providers ask, "Can this person manage at home?” Someone who lives alone, who is physically weak and whose burden of illness limits independence, is not safe at home. Alternatives can include a care home, a hospice, or a hospital. A person’s life expectancy often plays a role in determining the care setting.

Availability of resources is equally important in deciding where to care for someone. A person who wants to stay home needs support from family and/or friends, as well as their healthcare providers. The healthcare team won’t be in the home around the clock, so family and friends must be willing to participate in care. The healthcare team must anticipate possible symptoms so they can provide medications and other resource supports. In some parts of Canada, home care services may include providers trained in palliative care. Cooperation between the healthcare team and family or friends, can prevent possibly distressing symptoms and allow someone to die in comfort at home.

The choice of where to care for someone may come down to providing care in a setting where symptoms can be managed:

• A person may need hospital care. In some parts of Canada, there may be units intended to have patients stay in hospital for a long period. In other areas palliative care programs are community-based, and have a limited number of palliative care beds. In such programs the patient’s care is managed in the community, but they may be admitted to a designated palliative care unit within a healthcare facility, if necessary. The palliative care team there treats difficult symptoms and works to stabilize the patient. When that is achieved, the patient leaves the unit and goes back home, to a hospice, or to a care home.
  
  
• A person may die at home. Symptoms can often be managed at home. More planning is needed, but medications and other aspects of care are often the same as they are in a hospital. Some procedures can only be done in a hospital, and may require a short stay or a visit to a clinic.

One place is no better than another for receiving care. It’s usually the needs and wishes of the patient and family that determine the best place to receive care.