Ontario Doctors Sound Alarm on In-Home Palliative Care Quality

Concerns over the quality of in-home palliative care in Ontario have escalated, prompting two local doctors to voice their frustrations regarding the services provided by the Victorian Order of Nurses (VON). Dr. Alexandra Hodgson, who dedicated seven years to enhancing in-home palliative care in the Grey-Bruce region, made a significant career shift in 2024. She cited the inability to ensure safe care for vulnerable patients as the main reason for her decision.

“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,” Hodgson remarked. This change reflects a broader concern regarding the effectiveness of VON in delivering essential care to patients at the end of life.

Dr. Susan Batten, another palliative care specialist in the area, echoed Hodgson’s sentiments. She stated that unless VON is suspended from caring for complex palliative patients, she too will cease her home care visits. In a letter to Ontario Health AtHome, Batten emphasized, “I can no longer place my patients or myself at risk of such negligence.”

Many Ontarians express a preference to receive care in their homes during their final days, yet systemic issues are hindering this desire. Both physicians noted that VON is not the only service provider in the region, but they have consistently underperformed in delivering acceptable levels of care.

Concerns Over Patient Care

Batten highlighted the importance of teamwork and communication in effective palliative care, where nurses and doctors coordinate closely. When functioning well, nurses provide frequent home visits and have round-the-clock access to medical staff should a patient’s condition change. Unfortunately, this vital communication is often absent in homes served by VON.

The disparity in care quality between VON and CarePartners, another nursing provider in the area, is stark. “What I know is that CarePartners does this well and VON does not,” Batten stated. She has observed that VON has failed to meet palliative care standards since she began her practice in 2013.

The issues both doctors identified include:

– **Incomplete Patient Assessments**: Vital patient information, such as blood pressure and symptom changes, is often not recorded or communicated effectively. This results in doctors spending excessive time tracking information rather than focusing on patient care.

– **Medication Management Failures**: Patients relying on automatic pumps for pain management have suffered due to VON’s failure to refill medication or inform doctors about patient discomfort. In one instance, Batten noted a patient endured days of pain because the pump’s tubing had been disconnected.

– **Poor Patient Charting**: Basic data, like blood pressure readings, are frequently missing or inaccessible. Batten emphasized that this lack of basic record-keeping remains a persistent problem within Canada’s healthcare system.

Both Hodgson and Batten believe VON lacks an effective quality control system akin to what is found in hospitals and hospices.

Response from VON and Government Officials

In response to inquiries from CBC News, the Victorian Order of Nurses stated that they take these concerns seriously and are committed to close collaboration with physicians and Ontario Health AtHome to improve integrated care for clients. They mentioned ongoing efforts to enhance communication among all care providers involved with patients.

Both doctors acknowledged that VON nurses operate under challenging conditions, often receiving lower pay than hospital nurses and having to travel long distances, sometimes in adverse weather.

As the demand for home care grows, Hodgson is calling for greater transparency regarding the quality control measures in place for organizations contracted to provide in-home nursing care. She questioned why one organization can consistently outperform another under the same geographic constraints.

NDP Health Critic France Gélinas has publicly criticized the current home care system, describing it as “broken” due to a competitive bidding process that prioritizes cost over quality. Her office receives numerous complaints about the home care system, which she argues is exacerbated by long-term contracts lacking sufficient oversight.

“The companies try to out-bid each other on price, and that’s not how quality health care is provided,” Gélinas remarked. She highlighted that home care nurses are among the lowest paid in the province, contributing to high turnover rates and diminishing care quality.

The situation in Ontario exemplifies the ongoing struggles within the home care sector, raising critical questions about how to ensure that patients receive the compassionate and effective care they deserve in their final days.