University of Waterloo Greenhouse Design Initiative: Shedding Light on the Importance of Hospice Care
By Neel Bhavsar, Claudia Spengler, David Chobotov
Three University of Waterloo students are helping Hospice Waterloo Region find ways to counter misconceptions and increase referral rates earlier in the end-of-life trajectory, so that individuals and their families can benefit from needed services and support.
As part of the Greenhouse Workplace Innovation Program (WIP) at the University of Waterloo, we are a team of three students taking part in an 8 month project in which we are paired with a local organization and receive support from WIP in the process of investigating and solving a core organizational need. We are currently working with Hospice Waterloo Region (HWR), originally a community hospice care provider, which is now expanding their services to in-facility beds in the months to come. In this project, we are investigating ways in which the organization may broaden public understanding of hospice services and increase referral rate for hospice support earlier in a person’s end of life journey.
To investigate and solve this problem, we have divided our approach into three sections: problem investigation, solution ideation, and prototyping / testing. The first step in our problem investigation process was to collect as much information as possible about the hospice and palliative care systems. In doing so, we followed an inductive approach to our research by conducting informal interviews with key informants in geriatric care and palliative care, as well as healthcare practitioners.
From our research, we came to learn that many of HWR’s clients enter hospice care with only a few weeks left to live, and do not reap the full benefits of the palliative care process. We discovered that this is largely due to a reluctance among some communities, doctors, or families to make referrals based on misconceptions about what hospices actually are, and stereotypes surrounding palliative care. For example, many patients may perceive a recommendation to hospice as a sign that their medical team has given up, or that medical care has nothing left to offer. The reality is that hospices are much more than places people go to in order to transition from life to death. With the goal of improving quality of life in a patient’s final months, hospices focus on providing physical, emotional, spiritual, and practical support to both patients and families. Like other hospices in Ontario, HWR’s services and overarching philosophy are underpinned by the view that death is a journey both individuals and families must undergo, and that this journey does not have to be travelled alone. When dealing with terminal cases, a physician has the responsibility to inform their patients that the medical care system has not given up on them, and that a palliative approach to care, which includes hospice support, can be introduced earlier to provide opportunities that enrich a client’s life until death. By providing services such as professional counselling, legacy activities, physical / spiritual therapy, vigiling, group activities, and more, Hospice Waterloo Region supports people to keep living to their fullest potential within the constraints that their condition has placed them in. The problem we identified is that not enough people know this.
Before starting this project, our group recognized a series of assumptions which we had about hospice care which may prevent the general public from understanding the full extent of hospice services. The first assumption being that hospice care is strictly only an in-facility based system which provides care to clients and family of clients in the facility. This is not at all the case, as Hospice Waterloo Region was primarily an “at-home care service” even before the pandemic which focused on supporting individuals who were dying through counselling, 1:1 volunteer support and day program activities. That work also included support for caregivers and families dealing with the loss of a loved one. Another large assumption our group had at the beginning of the program was that you can only be referred to hospice through a primary care physician. This again is not true as you can refer yourself or a family member or a friend; this assumption prevents the possibility of more people reaching out to hospice care on their own to learn more about the extent of these services. Another large assumption includes the idea that services are not for family members or friends of clients in end of life care, the concept being that the services are again limited to direct care of the client. But hospice also supports family and friends in their everyday life, from buying groceries to providing rides in to the facility or work, whatever help may be needed. In order to address the increase of referrals overall it is important to directly approach these misunderstandings about hospice care which prevent full understanding of the services offered and the likelihood of all individuals including family members and friends, primary care physicians, and community members of making these referrals in the first place.
At this point in our project, we have finalized our problem investigation and are in the process of ideating solutions. Next steps for our team involve researching specific target stakeholders, and ideating solutions on ways to increase earlier referral rates from that specific target source. With the Greenhouse Workplace Innovation Program, we have had the chance to delve deep into an important issue which is part of a greater need for educating the general public about hospice services and the philosophy of palliative care. Our hope is that we are able to broach this larger problem with our solution. Bearing in mind that every step in the right direction can make a large difference in the end of life care of many individuals, we seek to prevent people from experiencing the “I wish I knew about how hospice could have helped me sooner” sentiment. We are very excited to see how our team will go about doing this in the months to come.
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