Where it All Began
From an early age, I was captivated by the medical field. I spent countless hours Googling images of internal organs, exploring medication names and their mechanisms of action, and diving into disease pathophysiology. My dream was to become a neurosurgeon, but the lengthy years of training led me to “settle” for nursing instead. Yet, it turned out to be more than just a fallback. Nursing has brought immense joy and gratitude into my life, offering me valuable skills in problem-solving, critical thinking, and communication. During nursing school, I got a tattoo on my forearm that reads, "Be fearless in the pursuit of what sets your soul on fire," believing then that nursing was my ultimate passion. Little did I realize that this journey would lead me to discover my true calling: End-of-Life care.
My Career as a Licensed Practical Nurse
Looking back, it's a bit ironic that before I became a nurse. I worked as a Continuing Care Assistant (CCA) in Nova Scotia, where I was adamant about avoiding home care. I had a clear preference for Long-Term Care and Hospital settings. However, my perspective shifted dramatically over just a few years, and I developed a genuine passion for community care. This newfound love led me to join the Victorian Order of Nurses when I became a nurse, where I began working with clients right in their homes. I started with bedside community nursing and eventually transitioned into a Home Support Supervisor role, which I've held for the past seven years. In this position, I manage and support both the CCAs providing home care and the clients receiving these services. Throughout my time in community care, I've developed a particular fondness for working with clients in the palliative stages of their lives.
While on maternity leave with my second son, I saw an opportunity to apply for positions at a newly opening Hospice facility in my area. I jumped at the chance, not realizing at the time how profoundly this decision would impact my career and ignite a deep desire to support those facing life-limiting illnesses and their families. For the past six years, I've been working as a casual Hospice nurse, and I can honestly say I've never regretted a moment.
In my role as a hospice nurse, I pour my heart into caring for patients and their families during their most challenging times. I've been fortunate to help manage symptoms, allow families to focus on their loved ones rather than caregiving tasks, and support clients in creating lasting memories with their families. My spouse often wonders how I handle aspects of the job, especially postmortem care, and I always respond with, “I have the privilege of providing the last acts of kindness that person will ever receive, especially after their death. How could I not do this?” His puzzled look and nod usually signal a shift to a new topic of conversation. I don’t expect him to fully understand my passion, just as he doesn’t expect me to grasp the intricacies of ironworking and construction.
What Brings Me to Home Hospice Association
Throughout my nursing career, I've witnessed firsthand the shortcomings of our healthcare system. It’s easy to feel disheartened and resign yourself to the status quo, thinking, “What can one nurse do to change anything?” I often found myself falling into a routine of caring for patients, going home, and repeating the cycle, feeling like all I could do was help people navigate a flawed system, one day at a time.
But I was wrong.
As I spent more time in palliative care, both in community and facility settings, my passion for End-of-Life care grew stronger. I knew I had to do more, so I began exploring the idea of becoming a Death Doula. I hadn’t even realized this role existed until I started researching. I reached out to my best friend, Chelsa, a social media manager, and told her, “Chelsa, I want to be a Death Doula.” Her enthusiastic response, “JESSICA! YES! This is PERFECT for you!” inspired me to pursue this new path. I discovered the Death Doula Association of Canada and their approved programs, quickly enrolled with Home Hospice Association, and jumped in with both feet. Here I am, embracing this new journey with a passion I didn’t even know I had
Deficits in End-of-Life Care
In my studies so far, I've delved deeply into End-of-Life care in Nova Scotia and was stunned to find that Palliative Care hasn't been reviewed in Nova Scotia since the 2014/2015 Nova Scotia Palliative Care Strategy Implementation Progress Report. It's been nine years since any significant evaluation or progress update on this crucial aspect of healthcare.
The 2014/2015 report highlighted the role of a Community Care Coordinator specifically assigned to support clients with life-limiting illnesses in the community. While this may have been implemented initially, it’s clear that no such dedicated role exists today. Now, Care Coordinators handle a range of care plans without a specific focus on End-of-Life care.
In Canada, many General Practitioners often feel unequipped to manage End-of-Life care and are unsure where to turn for support. Typically, they refer patients to Continuing Care for Home Support services, facility-based Respite, or Long-Term Care, and sometimes suggest Hospice care.
But what about everything else? Where do people turn for emotional support, financial assistance, food security, pet care, and education on life-limiting illnesses? What about physiotherapy for exercise and mobility, occupational therapy for home safety and equipment, or support for the loved ones of clients? Access to health services and knowledge about available options are also critical areas needing attention.
While Continuing Care does provide access to Physiotherapists and Occupational Therapists, there can be significant delays for home visits. I deeply value my roles in Community and Hospice nursing, but I am eager to do more to address these gaps in support.
In many hospice facilities, there's often a wide array of individualized activities designed to cater to patients one-on-one. However, there seems to be a noticeable gap when it comes to group activities for those who would like to participate. This lack of group engagement can be a missed opportunity for patients who might benefit from shared experiences and social interaction.
Additionally, the funding structure for these Hospices can sometimes lead to unintended consequences. Since financial support is often tied to bed occupancy, meaning that patients who might be better served in a Long Term Care setting may initially be admitted to a Hospice. This can lead to situations where patients are later transferred to Long Term Care facilities, which could have been avoided with a more tailored approach from the start.
Closing the Gap in End-of-Life Care
This is where my passion ignites—it's time to spark a change in End-of-Life care across Canada. To make a difference, you need to start small and work your way up. Think of it like making waves: you can't create a big splash without first making ripples, and to make ripples, you first have to throw pebbles.
Imagine you're at a playground with your children. As you watch them play, you pick up a handful of pebbles from the ground. Each pebble is unique, with its own shape, color, and size. When you let them fall back down, they work together to cushion any falls, protecting your child from a hard impact. Each pebble plays a part in the bigger picture.
In the same way, every action I take in my mission to improve End-of-Life care is like throwing a pebble. Whether I'm educating a client or their family, training CCAs and CCA students, joining or co-chairing a committee, or discussing my vision for change with friends and colleagues, each action contributes to a ripple effect.
Every pebble I throw creates a small ripple in the waters of change. When enough ripples come together, they form a wave. And each wave raises awareness, prompts thought, and eventually drives the recognition needed for meaningful change.
If you’ve taken the time to read this blog post, I encourage you to start throwing your own pebbles. Whether you begin with small actions or take bold steps, every effort counts. We need to ensure that those facing life-limiting illnesses, and their loved ones receive the care and support they deserve in their chosen environment, where they call home.
It’s time to be fearless in striving to improve End-of-Life care. One day, this will touch your loved ones, and eventually, it will touch you. Let’s work together to create the change we so desperately need to see.
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Jessica Richardson is an HHA Death Doula Candidate. You can learn more about Jessica and Elegant Grace End-of-Life Doulas on Facebook.
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