I have been a family doctor for 40 years. In my first year of practice, I visited a 64-year-old lady with terminal cancer in her home. I was touched by her pleasure in living at home with her loved ones, despite her bleak prognosis. By caring for her, I learned that the last year of life can be lived calmly and with dignity at home, provided that doctors join the home teams of the CLSCs. In our last year of life, the desire to live at home is natural: a person at the end of life is not a “dying”, she is a “living” who needs care.
For 40 years, I have cared for many patients at home thanks to the support of the CLSC de Verdun and the presence of young doctors providing 24-hour care, essential because of the inevitable deterioration. I have seen teenagers tenderly caring for their grandmother. I have seen 55-year-old sons take a long break from work to accompany an elderly father. I attended vigils full of songs and laughter, interspersed with tears, to say “goodbye” to the deceased.
I have seen young children and spouses sleep calmly near a dying person: life and death are experienced naturally and peacefully at home when doctors and nurses work as a team to provide rapid relief.
The establishment in Verdun of a 24-hour palliative medical team at the CLSC (called SIAD) is a success: in addition to a 50% reduction in costs, more than 60% of our patients remain at home until death ( against 11.8% for the province, the lowest rate in the West, where the average is 30%).
But our decision-makers unfortunately decided in 2019 to no longer allow SIAD doctors to treat a patient for more than seven days. While the end of life at home lasts an average of eight months, we are asked to abandon them on day 7. They are thus forced to return to each deterioration in our emergency rooms and overwhelmed hospitals.
Is this the “Quebec model” of end-of-life care? I do not believe that Quebeckers agree with a decision which makes the hospital the main place of palliative care, while the majority of seriously ill people want to be treated at home. I share with you the desire of an old family doctor: that all Quebecers with a terminal illness have the right to 24-hour home medical follow-up with their CLSC.