Many palliative care programs have an integrated approach to delivering care across settings. For example, the Calgary, Edmonton, Winnipeg and Fraser Health regions provide palliative care across settings - in the community, hospices, and in-patient palliative care units. This approach allows patients to transition from one setting to another, ensuring that they are cared for in the setting that best meets their needs.

Eligibility criteria common to many of palliative care programs include:

• The patient has a life-limiting illness with a prognosis of less than six months.
• The patient and their family have goals of care that align with the palliative care approach.
• The patient has agreed to a ‘do-not-attempt-resuscitation’ order.
  

Once accepted and registered with the palliative care program, a patient is typically assigned a palliative care coordinator. This experienced palliative care nurse coordinates community home care services, facilitates moves between care settings, and remains the key contact across care settings.

If the patient can live at home with support, a visiting home care nurse (with additional training in palliative care) will complete regular, holistic assessments. These assessments include evaluations of physical symptoms, functional level, and psychosocial and spiritual needs. The home care nurse works with the family physician, palliative care coordinator and other members of the palliative care team to plan care that best meets the patient’s needs.

When a patient doesn’t have the social supports or desire to be cared for at home, and doesn’t require acute medical care, a hospice setting may better meet his or her needs. A community hospice offers a slightly longer period of care giving, usually one to three months.

In-patient units typically provide more intensive care for shorter periods of time, which includes:

• Final days/hours of care for those imminently dying;
• Complex symptom management;
• Adjustment of medications;
• Palliative care emergencies such as pain crisis, spinal cord compression or bleeding;
• Complex psychosocial and spiritual issues;
• Relief of caregiver exhaustion; and
• Complex decision-making that community resources may not be able to address.
  

For additional information on palliative care delivery, listen to palliative care experts in The Gallery.