Facing life with an advanced illness can be intimidating, both for patients and their caregivers. From what can feel like endless doctors’ appointments to navigating complex medical decisions, the path forward isn’t always clear. But there is support available.
Pilgrims Hospice Society in Edmonton offers Community Care Navigation—a free service that helps individuals with advanced illness and their families understand their options, make informed decisions, and plan for the future.
Rooted in compassion and guided by expertise, the Community Care Navigation team can help patients and their caregivers find clarity, make sense of the unknown, and feel supported through every decision. Alanna Posteraro, a registered nurse and care navigator for Pilgrims Hospice Society, says the service is meant to help patients and families navigate what can often seem like fragmented palliative care.
“Typically, people will receive a palliative diagnosis and they jump, for example, from their primary care physician and then over to the Cross Cancer Institute, and then they’re discharged and then maybe they need to find a new physician who can come and visit them in their home if they are not physically able to leave any longer,” said Alanna. “Perhaps they need to transition from regular home care to palliative home care, and then maybe they need hospice. Maybe they want to stay home for end of life. There are lots of different teams they need to connect with. A lot of times they’re very unfamiliar.”
The Community Care Navigation team can help make sure that patients are connected to the right team at the right time. The services they provide include
- answering questions about care and treatment options (e.g., the Cross Cancer Institute, the Pain & Symptom Team, Palliative Home Care, hospice) and when to transition between them,
- explaining medical terms and what to expect,
- pet care and rehoming,
- grief support and spiritual care,
- advanced care planning information,
- finding a primary care doctor who specializes in palliative care, and
- referrals to community services.
Ideally, the Community Care Navigation team looks to help patients and their caregivers as early in their palliative diagnosis or end-of-life trajectory as possible, so they can support any changes in their care needs. Alanna can’t overstate how important this type of support is to those who need it.
“I think, as anyone who has cared for someone through their end-of-life journey can attest, it is a huge undertaking,” said Alanna. “In Canada, that responsibility often falls to one primary person carrying the load, often a daughter or a spouse or a mother. And these people have families, own homes, and have their own jobs that have to be taken care of. On top of that, they’re also caring for the person who is ill, taking care of their needs, managing medications, while processing their own grief and helping this person who’s ill manage their grief. It’s so multifaceted. A lot of times, people are just trying to keep the train on the track in terms of keeping appointments straight and medication administered, and all of these other things can fall through the cracks. What we aim to achieve is to help them through this journey without having to think of all the logistics and having to do all the research and make all the connections themselves. We help lighten the load so they can just focus on making sure that they’re caring for their loved ones and caring for themselves.”
Alanna also noted that pharmacy teams are a vital part of providing care to someone who has received a palliative diagnosis.
“Community pharmacies are a central factor in how we help people move through their palliative journeys,” she said. “Almost everyone in a palliative trajectory is on some sort of medication, often many medications. These things can be very overwhelming not only for the client to take care of, but also for their family or a loved one to try to keep track of. A lot of these medications are foreign, or they’ve heard misinformation about things like opioids in the news. We rely on pharmacists to provide accurate information about these medications and be part of every single team that’s surrounding a person who is ill.”
Pharmacy teams in the Edmonton area who provide services to palliative patients are encouraged to reach out to the Pilgrims Hospice Society at referrals@pilgrimshospice.com for more information about the Community Care Navigation Program and how they can refer patients to this service.
Pilgrims Hospice Society also offers a Home Visiting Hub program, which allows care providers in the community, such as pharmacy teams, to connect palliative patients in the Edmonton area with a physician who may be able to provide care in the patient’s home, including assessments and writing prescriptions.
