Home-based palliative care in Canada: time for this to be an option for everyone

I applaud Dr. Laupacis' commentary on home-based palliative care and the need for a shared care model to be available for all Canadians. I am, however, acutely aware that this option is not available for the vast majority of people living in rural and remote communities in Canada. Rural and remote Canadians are less likely to have primary care providers than urban Canadians (1). In the rural community in which I work as an emergency physician, we have no palliative care service outside of the hospital, no palliative specialists in town, and no cardiologists in town. The closest specialists in our province are more than 500km away. At one point we had a single nurse practitioner providing home palliative care but she became burnt out and, feeling unsupported, left the position.
When rural and remote Canada cannot keep the ER open for lack of primary care physicians (as that is who provides emergency care in small communities), how can we begin to look at adequately serving the palliative care needs of those at home? One's postal code should not determine the quality and availability of care, but it does. We must address these urban/rural discrepancies in CMAJ articles and suggest remedies that will help all Canadians.

SM Giles, CCFP(EM), FCFP, DTM&H
Emergency physician and hospitalist
Kenora, Ontario

Wilson CR, Rourke J, Oandasan IF, Bosco C; On behalf of the Rural Road Map Implementation Committee; Au nom du Comité sur la mise en œuvre du Plan d’action sur la médecine rurale. Progress made on access to rural health care in Canada. Can Fam Physician. 2020 Jan;66(1):31–6. PMCID: PMC7012120.