Strengthening our Long Term Care Together:
Embedding Palliative Approaches to Care (EPAC) Spread Collaborative


 

The EPAC Collaborative will advance the shared priority of providing end-of-life care for both residents and their families in their homes, including support for all affected by the death of that resident.

 


Call for Applications

CFHI is inviting teams across Canada to apply for the EPAC Spread Collaborative from June 2018 to October 2019.

What is EPAC

EPAC (Embedding a Palliative Approach to Care) is a successful model of care developed by Jane Webley, Regional Leader, End of Life, at Vancouver Coastal Health. EPAC improves care at the end-of-life for residents in long term care, their family, surviving residents and the healthcare team. The approach involves the early identification of residents likely to benefit from a palliative approach to care, focusing on goals of care discussions and effective communication between providers and families.

 

Apply Now

 

Key Dates

Key Dates

 

Key Dates

  • April 16, 2018: Call for applications
  • April 16 - May 25, 2018: Pre-application informational calls available upon request
  • May 1, 2018: Informational webinar 
  • May 25, 2018: Deadline for submission of application (EPAC Expression of Commitment)
  • June 8, 2018: Communication informing teams of their selection
  • June 15, 2018: Introductory webinar (for selected teams)
  • June 2018 - June 2019: Webinars and coaching
  • June 18, 2018: Deadline for signed memorandum of understanding (MOU)
  • June 18 &19, 2018: Collaborative launch workshop
  • July - September 2018: Pre-implementation period and training
  • September 2018 - October 2019: Implementation period
  • October 2019: Results webinar (date to be confirmed)

EPAC Overview

Residents in long term care homes are highly likely to die there1, underscoring the need for implementation of consistent, systematic palliative care. Providing quality palliative care not only supports the needs of residents, it empowers staff to care for dying residents and grieving families and it allows homes to meet the expectations of families and the public that quality palliative care is an embedded component of the care available to residents.

Jane Webley initiated EPAC (Embedding a Palliative Approach to Care) at Vancouver Coastal Health in British Columbia to understand the barriers to enabling well-planned and coordinated end-of-life care for people in long term care homes. The approach involves the early identification of residents likely to benefit from a palliative approach to care, focusing on goals of care discussions and effective communication between providers and families. Offering a common, consistent approach to supporting residents who are near the end-of-life creates opportunities – and provides permission – for death and dying to be openly discussed and normalized. This approach has been shown to be instrumental in successfully shifting the culture and improving the end-of-life experience for both the resident and their family, and for the surviving residents and the healthcare team.

Based on a careful root cause analysis, the project team, which included residents and families, identified four goals:

1. Every resident will have a documented goals of care discussion early before their death

2. All stakeholders will be supported at the time of a resident’s death

3. All stakeholders will have access to honest, relevant information and education

4. Goals of care will be respected across the healthcare continuum

The pillars of the EPAC model are flexible, enabling individual homes to adopt and adapt them to their unique local needs and strengths (see Figure 1).

EPAC-pillars-e

Figure 1

Testing the Innovation

From 2012-2017, EPAC (previously known as DAISY) was implemented in 48 longt erm care homes, including urban and rural sites and homes caring for specialized populations such as acquired brain injury (ABI), Amyotrophic Lateral Sclerosis (ALS) and marginalized persons across Vancouver Coastal Health. The initiative demonstrated success in enabling residents to receive improved end-of-life care at home, avoiding unnecessary hospital transfers and supporting all stakeholders through the experience.

The project team has trained leaders and site champions, increasing capacity and capability in the delivery of a palliative approach to care, increasing confidence to discuss goals of care with the resident or substitute decision maker, and contributing to cross-sector benefits for both acute and long term care. The initiative achieved a 60% decrease (n=75) in ED transfer rates without admission, and a 27% (n=276) reduction in number of days residents spent in acute care.

Family members expressed their confidence in the care both they and the resident receive:

“The staff supported our family completely. They helped us prepare and make arrangements in advance. We appreciated staff coming to say goodbye.”

“The palliative approach was comforting knowing that my Mum would die in a place that she felt cared for and we felt at home here.”             


1Hospice and Palliative Care | Long Term Care | Projects and Advocacy. Retrieved March 09, 2018, from http://www.chpca.net/projects-and-advocacy/eol-care-in-ltc.aspx
Nadin, S., Miandad, M. A., Kelley, M. L., Marcella, J., & Heyland, D. K. (2017). Measuring Family Members’ Satisfaction with End-of-Life Care in Long-Term Care: Adaptation of the CANHELP Lite Questionnaire. BioMed Research International, 2017, 1-17. doi:10.1155/2017/4621592