“Palliative care: Should we fear the closing of units? “ this was the theme of the day organized by Jeanne Garnier Medical House at the national assembly, on last 9 May. While we are talking a lot about palliative care and Leonetti law of 25 April 2005 insists on the emergency to develop the accompaniment at the end of life, what is going on in France today?
Report of the Court of Accounts
A Court of Accounts report from September 2005 1 notices that France remains very different from recommendations of Social and Economic Council which advocates 5 beds for palliative care per 100,000 inhabitants (currently the average is 1.2 beds). It also insists on the inequalities of access to palliative care, for geographic (Centre, South-West of France, rural areas and those with a high old population being badly equipped with palliative care hospital structures) as well as pathologic level. If patients with cancer are relatively well accompanied, old people have a reduced access, as well as other patients with other pathologies, like advanced neurological, cardiac, pulmonary and Alzheimer diseases… Finally, the Court of Accounts regrets that the financial means allocated these last years to Regional hospitalisation agencies (ARH) for palliative care have not been integrally spent: the utilization rate of this budget was about 61% in 2001 and 40% in 2002. The ARH had to meet others priorities from Health Ministry…
The organization of palliative care
Three types of structures exist, which accompany patients at end of life :
- Palliative care units (PCU) which provide care, training, education and clinical research, 78 in France;
- Mobile palliative care team (MPCT), there are 326 but several French departments are still short on;
- Palliative care networks and home care services (HCS), there are 93 in 58 French departments and 23 regions.
In France, two out of three admission demands has a negative issue, and it is observed that the number of beds in PCU decreased by more than 6% between 2002 and 2003 (from 834 to 782) and that medical staff decreased from 107 to 91 for the same number of beds. Yet, Léonetti law, which leads to take decisions to limit or stop active treatment, naturally orientates numerous patients towards palliative care units that cannot accommodate them due to a lack of space!
Satisfaction of families
94% of families have been satisfied or very satisfied with the pain management of their relatives. But a lot of them regrets they had to wait before being accommodated, due to the lack of space in palliative car units (55%) or the bad organization of health services.
Living place and school of life
A poll carried out towards families who had a hospitalized relative at Jeanne Garnier’s shows that for 67% of them, it is a living place and not a deathtrap and that time spent in this place was useful by enabling them to live an intense period and deep exchanges with their relatives. Palliative care units are also a school of life. While medicine students finish their studies without having received training worthy of the name as regards relationship and medical ethics, Marie de Hennezel proposes, in her report, an obligatory period in palliative care service during their studies. This measure is not yet feasible today, due to the reduced number of existing units.
1. Report never published and mentioned in La Croix, 9 May 2006.