Contract issues put up barriers for some to hospice care in Kelowna

Contract issues at the Central Okanagan Hospice House means some patients will be unable to enter the facility, and will instead have to spend their final days in an overcrowded hospital.

Since June 30, a group of family physicians in Kelowna who supported the palliative care needs of doctorless patients entering the hospice has been without a contract. As a result, those doctors are no longer doing that work.

A dying patient is not allowed to enter the hospice without being attached to a general practitioner. Some family physicians, for a variety of reasons, choose to not follow their patients into hospice, while others are not allowed to.

That means those “unattached” or “orphan” patients that were previously cared for by the Palliative Care Family Physician Group can no longer enter hospice and must die in the far-less-comfortable hospital.

“Everyone deserves the best quality of care until the end of life,” said Dr. Joshua Nordine, a family practitioner at Rutland Medical Associates.

“While I appreciate the care and dedication patients receive in hospital, I believe the availability of staff to provide hands-on comfort care and patient support at a community hospice facility is superior.”

Dr. Nordine, due to not being vaccinated for COVID-19, is not allowed to follow patients into the hospice, as it’s an Interior Health facility.

“We should allow unvaccinated physicians like myself back in to work Interior Health run facilities so I can care for my own patients instead of trying to find an alternate accepting physician,” he said.

While Dr. Nordine is willing to provide hospice care, he says there are plenty of family doctors who choose not to. Those who follow their patients into hospice typically do it on compassionate grounds after building up a relationship with a patient over years.

“They trust you, they're the most vulnerable, and you’ll be the one there holding their hand, in their time of need,” Dr. Nordine said. “It's a service that we do for our patients, honestly. It's a sort of a bit of a community service. It's not a dollar thing.”

But many overworked general practitioners simply don’t have the capacity for that community service.

“It's just too disruptive for your practice, or you don't have the time to commit,” Dr. Nordine said. “It's getting harder and harder to commit to outside-of-your-clinic care.”

In a statement to Castanet, Interior Health says they are seeing high numbers of unattached patients across the Central Okanagan, both in palliative and non-palliative patient groups.

“IH is actively working with physicians and the Division of Family Practice to identify options to support smoother transitions in care and access to hospice,” Interior Health said.

The Central Okanagan Division of Family Practice deferred comment on the operations of hospice house to Interior Health, but confirmed in a statement that the Palliative Care Family Physician Group is no longer providing care to unattached patients at the hospice.

Exactly why the group of doctors is now without a contract is not known. IH's statement did not acknowledge the contract situation, and the Division of Family Practice would only confirm that the contract has now expired.

IH says it has added additional nursing leadership and support at hospice to support care and admissions seven days a week, in addition to other resources.

IH noted Kelowna General Hospital has four palliative care beds where end-of-life care can be provided. KGH was operating at 120% capacity on Sept. 21.

Dr. Nordine, meanwhile, says the hospital is not a substitute for the hospice.

“You'll still get the care in the hospital, but it's not the right place for a lot of these patients,” he said, calling the Central Okanagan Hospice House an “amazing, calm, peaceful facility filled with genuinely caring, compassionate staff providing hands-on, end-of-life comfort and support.”

“We need to ensure any barriers to admission to community hospice facilities are immediately remedied and that timely access to Hospice House isn't a luxury for those with a primary care physician.”