Ontario Doctors Demand Changes to Palliative Home Care Standards

Issues surrounding the quality of in-home palliative care for dying patients in Ontario have prompted serious concerns from medical professionals. After seven years of providing care in the Grey-Bruce region, Dr. Alexandra Hodgson made a significant career shift in 2024, stating that the inadequacies of the Victorian Order of Nurses (VON) made it impossible for her to continue. “I couldn’t leave a patient’s home anymore with the stress and anxiety of not knowing what was going to happen to that person until I came back in a week,” she explained.

Hodgson’s decision reflects a broader discontent among doctors in Ontario regarding the quality of nursing care for vulnerable patients. She now focuses her efforts on palliative care within hospice and hospital settings in the Owen Sound area. Dr. Susan Batten, another palliative care physician, echoed Hodgson’s sentiments, threatening to withdraw from home care visits unless VON’s role in managing complex palliative cases is reassessed. “I can no longer place my patients or myself at risk of such negligence,” Batten stated in a letter to Ontario Health AtHome, the governing body managing home care services.

Most Ontarians prefer to die at home, yet the current system often fails to meet this desire. Both doctors have criticized VON for consistently delivering below-standard care, identifying numerous systemic failures that hinder effective patient management.

Systemic Failures Highlighted by Local Physicians

Batten describes an ideal home care system where nurses and doctors communicate effectively, allowing for timely adjustments to patient care. Unfortunately, this communication often breaks down with VON nurses, leaving critical gaps in care. “What I know is that CarePartners does this well and VON does not,” Batten noted, further asserting that VON has not met basic standards for palliative care since she began her practice in 2013.

The deficiencies attributed to VON include incomplete patient assessments and inadequate symptom tracking. Basic data such as blood pressure readings and pain medication levels frequently remain unrecorded, leading to a situation where doctors must spend valuable time searching for information instead of focusing on patient care. Furthermore, improper medication management has led to unnecessary suffering for patients reliant on automatic pumps for pain relief. In one alarming instance, a patient endured days of discomfort due to a disconnected pump.

Both doctors have emphasized that the lack of proper patient charting is a pervasive issue within Canada’s healthcare system. Batten stated that even straightforward charting tasks, such as recording blood pressure, are often neglected by VON nurses. This absence of quality control mechanisms contrasts sharply with the protocols found in hospitals and hospice environments.

Calls for Transparency and System Improvement

In response to inquiries from CBC News, only VON provided a statement, acknowledging the concerns raised by physicians. The organization expressed its commitment to enhancing communication and ensuring integrated care for clients. VON reiterated that it is actively working to improve the continuity of care and the accessibility of patient information.

Both Hodgson and Batten recognize that VON nurses face challenging working conditions, including lower pay compared to hospital staff and the demands of traveling across vast rural areas, often in adverse weather. This context is crucial in understanding the difficulties faced by home care providers.

Advocates for improved home care in Ontario argue that transparency regarding quality control is essential. “We have these two organizations that work in the same area with the same set of challenges, and so why have we gotten to a point where one organization is so much better than the other?” Hodgson questioned.

The Ontario New Democratic Party’s Health Critic, France Gélinas, highlighted the systemic issues within the home care framework, claiming that competitive bidding for nursing contracts has severely compromised the quality of care. “The companies try to out-bid each other on price and that’s not how quality health care is provided,” she asserted. Gélinas indicated that her office receives continuous complaints about the home-care system, which she described as fundamentally flawed.

The situation presents a pressing challenge for the Ontario health system, where ensuring quality care for dying patients in their homes remains a significant concern. As medical professionals call for reform, the future of in-home palliative care in Ontario hangs in the balance, with the need for immediate action becoming increasingly urgent.