Sarah Rennie – LJI reporter

Most people want to stay in their home for as long as possible, but for those receiving palliative care, this is not always an option. A new program in the Haut-Saint-Laurent could change this.

The Centre Intégré de Santé et de Services Sociaux de la Montérégie-Ouest (CISSSMO) launched an innovative new service in December. A team of nurse practitioners can now take charge of palliative care patients who do not have access to a physician and provide follow-up care at home.

The service is based on a close collaboration between area nurse practitioners working with the family medicine groups (FMG) in Ormstown and Huntingdon and the home care nursing team at the Huntingdon CLSC. It was initiated by Mélanie Pinsonneault, a nurse practitioner with the Ormstown FMG, who felt some patients would greatly benefit from receiving palliative care and end-of-life services at home. She proposed the idea to the management team at the CISSSMO and six other nurse practitioners who readily agreed, and within three months, the program was up and running.

It is designed for patients who do not have a family doctor, or whose doctor is either unfamiliar with palliative care or located too far away. Patients may be referred by a doctor, but in most cases, it is the CLSC home care nursing team that flags patients that fit the program criteria. Pinsonneault then assigns the patient to one of the seven nurse practitioners, depending on their location and expertise.

While similar initiatives exist for doctors, the CISSSMO’s program is unique in Quebec as it is run solely by nurse practitioners. In fact, the CISSSMO points to the program as a good example of what can be done now that the provincial government has expanded the role of nurse practitioners to include palliative care services and medical assistance in dying.

“We provide comprehensive care and complete medical follow-up at home,” says Pinsonneault, who has been working as a nurse practitioner since 2019. She says the role has evolved significantly, from not being able to diagnose patients when she first started, to being completely independently responsible for a full patient load. The team of nurse practitioners associated with the project are all responsible for patients with varied medical needs within their FMG, but they also participate in various projects. The palliative care initiative fit well with their role and the therapeutic relationship they build with their patients

Despite the workload, Pinsonneault says palliative care is something she has always been drawn to, and she and the other nurse practitioners are happy to take on additional patients if it means those patients can remain at home. “We take care of everything, from the medical side to symptom management, prescribing medication, and monitoring,” she explains.

Palliative care provides support to patients, families, and caregivers. The goal is to optimize quality of life while mitigating or reducing suffering for those with serious, often terminal illnesses. “It can last a year, it can last two years,” says Pinsonneault, who suggests this is why the new program is so important.

“It is a complete care team,” she says, while explaining how the nurse practitioners work closely with CLSC nurses, practical nurses, and care professionals to provide patient care and follow-up on an on-call basis when needed.

“It leads to fewer emergency room visits,” says Pinsonneault, and ultimately, to happier patients, whose end-of-life care needs are respected.