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The Health of Canadians – The Federal Role
The Final Report on the state of
the health care system in Canada
Volume Six: Recommendations for Reform
Standing Senate Committee on Social Affairs, Science and Technology
October 25, 2002
Introduction
The Kirby Report can be found at www.parl.gc.ca.
This report is comprehensive and over 300 pages in length.
The purpose of this brief report is to inform you on what the main
areas of recommendations are and to summarize Chapter Nine entitled
“Expanding Coverage to Include Palliative Home Care” found on page
163-167.
Summary
of Recommendations
This six and final
report of the Senate Committee often referred to as the Kirby report
contains recommendations for reform and renewal of the Canadian health care
system and flows from the principles stated in report five.
The
recommendations contained in this report are grouped into six categories.
- Recommendations
on restructuring the current hospital and doctor system to make it more
efficient and more effective in providing timely and quality patient
care;
- Recommendations
on enacting a health care guarantee that would ensure that patients
receive treatment within a specified maximum amount of time for major
hospital or diagnostic procedures: if the waiting time is exceeded, the
health care guarantee would require the insurer/government to pay for
the cost of the patient receiving the necessary service in another
jurisdiction or another country;
- Recommendations
on expanding public health care insurance to include coverage for
catastrophic prescription drug costs, immediate post-hospital home care
costs, and costs of providing palliative care for patients who choose to
spend the last weeks of their lives at home;
- Recommendations
that strengthen the federal contribution to, and role in developing
health care technology, the evaluation of health care systems
performance and outcomes, the supply of health human resources, health
research, wellness promotion and illness prevention, and the nation’s
16 Academic Health Sciences Centres;
- Recommendations
on how additional federal revenue should be raised, and on how this new
revenue should be administered in a transparent and accountable manner
in order to implement the recommendations in this report;
- Observations
on the consequences that would arise if the additional federal revenues
that the Committee recommends be raised are not invested in the health
care system.
The
report suggests that some of these recommendations will require the
financial participation of the provincial and territorial governments and
wants to foster a spirit of cooperation and collaboration among various
levels of government.
Summary
of Chapter Nine entitled “Expanding Coverage to Include Palliative Home
Care” (page 163-167)
The committee acknowledged the number of presentations that brought end-of-life
issues to their attention.
The
report states that the goal of palliative care is to provide the best
possible quality of life for the terminally ill by ensuring their comfort
and dignity and relieving pain and other symptoms. Palliative care is designed to meet not only the dying person’s
physical needs but also his or her psychological, social, cultural,
emotional and spiritual needs and those of his or her family as well.
9.1
The Need for a National Palliative Care Program
The committee believes that there is a clear need to ensure that proper
palliative care is universally available, and that it is provided in a
manner that respects the wishes of the dying person and his or her loved
ones.
While
the committee is aware that there are important limits to what the federal
government can achieve directly in this area, it is nonetheless convinced
that it is essential for the federal government to make a substantial
contribution to making palliative care services available to Canadians in
their homes.
Recommendation
The
federal government agree to contribute $250 million per year towards a
national Palliative Home Care Program to be designed with the provinces and
territories and co-funded by them on a 50:50 basis.
9.2 Financial Assistance to
Caregivers Providing Palliative Care at Home
In addition to helping to establish a national program to pay the costs of
end-of-life care for Canadians who choose to die in their own homes, there
are also other measures that the federal government should consider in order
to alleviate the burden that now falls on the shoulders of thousands of
informal caregivers.
Many
working Canadians are faced with stark choices as they try to balance the
need to provide for their families with caring for a terminally ill family
member. Minimizing the amount
of lost income during this temporary but very difficult period would be an
important first step towards improving the situation facing family
caregivers of dying individuals.
Recommendation
The
federal government examine the feasibility of allowing Employment Insurance
benefits to be provided for a period of six weeks to employed Canadians who
choose to take leave to provide palliative care services to a dying relative
at home.
9.3 Caregiver Tax Credit
The
1998 budget recognized that families caring for an ill loved one required
government assistance, and implemented a tax credit that applies to
individuals residing with, and providing in-home care for, an elderly parent
or grandparent or an infirm, dependent relative. This credit reduces combined
federal-provincial tax by up to $600.00.
Recommendation
The
federal government examine the feasibility of expanding the tax measures
already available to people providing care to dying family members or to
those who purchase such services on their behalf.
9.4 Job Protection
The
provinces have responsibility for labour legislation including job
protection. However the federal
government has jurisdiction over federal public service, military personnel
and individuals working in federal penitentiaries.
Recommendations
The
federal government amend the Canada Labour Code to allow employee leave for
family crisis situations, such as care of a dying family member, and that
the federal government work with the provinces to encourage similar changes
to provincial labour codes.
The
federal government take a leadership role as an employer and enact changes
to Treasury Board legislation to ensure job protection for its own employees
caring for a dying family member.
Closing
Statement from Report
The
federal government is in a position to provide strong leadership and support
for dying Canadians and their families, in particular by ensuring that
Canadians who choose to die at home have access to the services that they
need to do so with dignity.
All
in all, a good summary of the issues that are of relevance to the federal
government. Please refer to the full Kirby Report for more details.
Prepared
by Sharon Baxter
Executive
Director, Canadian Hospice Palliative Care Association
October
27, 2002
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