Chapter 25: Chronic, Long-Term & Palliative Care

Chronic, Long-Term & Palliative Care highlights the transition from traditional acute-care perspectives to comprehensive frameworks like the Chronic Care Model and specifically the Canadian Expanded Chronic Care Model (ECCM), which integrates clinical management with population health promotion and community action. The text details the continuum of long-term care, spanning from home-based support and medical equipment provision to high-intensity residential facilities, while addressing critical safety concerns such as resident-to-resident violence and the leadership role of nurses in facility settings. A significant portion of the discussion is dedicated to hospice palliative care, advocating for a holistic "palliative approach" that begins early in the illness trajectory rather than only at the very end of life. This approach focuses on symptom management, psychological and spiritual support, and bereavement care for families. Furthermore, the chapter critically analyzes the vital yet often overlooked role of family caregivers, examining the physical, emotional, and financial strains they face alongside the rewards of caregiving. Throughout the material, the importance of health equity is emphasized, particularly the need for culturally safe and accessible care for Indigenous, rural, and marginalized populations. By applying various levels of prevention—from primordial to quaternary—community health nurses are encouraged to advocate for healthy public policy and social justice to improve the quality of life for those living with and dying from life-limiting conditions.