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Health systems in transition Canada 113
sustainability of this policy. One research study concluded that the higher the
proportion of non-kin, male and geographically distant members that make
up a given patient’s informal care network, the less sustainable the care (Fast
et al., 2004). In some cases, informal caregiving, may be inadequate. There
also appears to be an urban–rural divide in the support of informal caregivers
with many more programmes in place for urban caregivers (Crosato & Leipert,
2006). There are also major differences in terms of the quality of home-support
services more generally (Sims-Gould & Martin-Matthews, 2010).
5.10 Palliative care
Since the terms “hospice care” and “palliative care” are used interchangeably
in Canada despite their different historical meanings (Syme & Bruce, 2009),
the term “palliative care” as used here includes both forms of care. Wright et al.
(2008) have demonstrated that there is a positive correlation between income
as well as human development, as measured by the United Nations’ Human
Development Index (HDI), and the availability of palliative care services across
countries. As such, Canada is similar to high-income and high-HDI countries in
the OECD in terms of the provision and integration of palliative care services.
Similar to the overall public–private split in the funding of health care, slightly
more than 70% of palliative care services are publicly funded through F/P/T
health plans (Dumont et al., 2009). 3
The level of public funding is due in part to the fact that most palliative
care in Canada is provided to patients dying of cancer, who, in turn, receive
a substantial amount of end-of-life care in hospital, despite in some cases the
preference for home-based palliative care (Leeb, Morris & Kasman, 2005;
Widger et al., 2007). However, in recent years, there has been a dramatic shift
in the location of end-of-life care. In the period 1994–2004, the proportion of
Canadians dying in hospital dropped from 77.7% to 60.6% while those dying
in long-term care facilities rose from 3% to 9.9% and those dying at home rose
from 19.3% to 29.5% (Wilson et al., 2008).
Since it was founded in 1991, the Canadian Hospice Palliative Care
Association (CHPCA), a charitable non-profit-making organization, has been a
consistent advocate for improving access to palliative care outside hospitals, and
for the setting of national norms and practice guidelines for outpatient palliative
care (Canadian Hospice Palliative Care Association, 2002). This is due in part
3 The federal government is mentioned in this context because Veterans Affairs Canada offers palliative care
services to eligible veterans of the Canadian Armed Forces.