Different types of care

What is Intensive Care?

Patients may be in the ICU because of:

• • severe infection or bleeding
• • breathing problems
• • a bad accident
• • major surgery

Along with strong medicines, there are several machines used in the ICU, including:

• • ventilators or breathing machines
• • mechanical pumps to keep the heart beating
• • intravenous catheters (small plastic tubes put into big veins) that are used to provide medications
• • plastic tubes placed into the stomach to provide medications and nutrition

Outcomes of ICU Care

Most patients recover from a serious illness when admitted to the ICU, especially if they have had a short stay. However, if you are in the ICU for some time, you may leave the hospital being much weaker than you were before you became ill and, you may have problems thinking or concentrating. Also, up to half of survivors will have significant depression, anxiety, or post-traumatic stress disorder in the months that follow illness. Without intensive care, most seriously ill patients with organ failure will die. However, even with intensive care, some patients will die from their serious illness. On average, about 20% of ICU patients will die and 80% will survive and leave the hospital. For most people:

This survival rate can be higher or lower, depending on specific cases – for example, if you have a severe infection, or if you are in the ICU to recover from major surgery. Age can also make a difference.

Overall Risk and Benefits of ICU Care:

Is ICU Right for Me?

Most people who pick ICU care have fixable medical peoblems along with a reasonably high level of function of quality of life and are willing to accept the burdens or risks of ICU treatment. The Intensive Care video on the side of this page shows a discussion between a doctor and a patient talking about care in the ICU.

What is Medical Care?

People who are receiving medical care on a hospital ward usually have conditions such as:

• • less severe infections
• • problems due to an ongoing disease, such as diabetes
• • mild heart attacks or strokes
• • the need to recover after a surgery

Along with medications, some of the machines used to treat you in a general ward are:

• • intravenous tubes (IV) to deliver medications and nutrition
• • tubing to deliver oxygen but not ventilators or breathing machines
• • blood pressure monitors
• • specific machines for a disease, such as a dialysis machine

Outcomes of Medical Care

When admitted to hospital for medical care, most seriously ill patients recover from their serious illness and have little or no decrease in their quality of life. Approximately 70% will survive and leave hospital alive. However, the survival might be higher or lower depending on the age and health condition of the patient before they got sick.

If you are over 80 your chances of survival are different than if you are younger.

Overall Risks and Benefits of Medical Care

Is Medical Care right for me?

Most people who pick this option have fixable medical problems, or a declining or low level of function or quality of life and wish to avoid the more burdensome ICU treatments. The Medical Care video on the side of this page shows a conversation between a doctor and a patient about Medical Care:

What is Comfort Care?

Comfort care can be provided in a hospital, a long-term care home, a hospice, or at home. The goal is to keep you as comfortable as possible, but not to focus on curing you. For example, you may receive medications to help with pain or breathing problems, but you may not receive treatments (such as a breathing tube or CPR or even antibiotics) that would keep you alive longer, but may cause pain or make you uncomfortable. This is sometimes called a “palliative care approach” and may or may not involve services from palliative care clinicians.

Outcomes of Comfort Care

Most people who choose comfort care have serious medical problems that can’t be fixed. They may also be very old or have a poor quality of life and don’t want any treatments to help them live longer. Instead, they would rather be made comfortable. About 95% of patients with a serious illness who receive comfort care do not survive their illness. But they are much more likely to experience a higher quality of life at the end of life, with a more natural death that doesn’t include the use of many machines or being in the intensive care unit.

Overall Risks and Benefits of Comfort Care

Is Comfort Care right for me?

Most people who choose comfort care have serious medical problems that can’t be fixed. They may also be very old or have a poor quality of life and don’t want any treatments to help them live longer. Instead, they would rather be made comfortable only. This Comfort Care video on the side of this page shows a conversation between a doctor and a patient about comfort care:

Best location of care for you or your loved one?

Some people will develop a serious illness while residing in a long-term care home. For many patients, staying at their residence, rather than be transferred to hospital, is viewed as desirable. Long-term care homes are able to provide a variety of medical treatments, such as oral antibiotics for infection or x-rays on site in order to minimize the need for transfer to acute care hospitals. Long-term care homes are also able to provide comfort and palliative care to support those residents who no longer wish to be transferred to hospital or have chosen to pass away at home in long-term care. However, there may be situations where a long-term care physician may recommend a transfer to acute care when one requires care that is not offered in long-term care (e.g. intravenous medications, more intensive monitoring, or surgery).

Transferring to acute care has some risks and benefits. It will be important to discuss you or your loved one’s values and medical condition with the clinical team in the long-term care home in order to understand what medical services can be provided if a serious illness develops while residing at the long-term care home.

Is transferring to hospital right for you or your loved one?

Acute care hospitals can offer more aggressive and intensive care when managing serious illnesses. Thus, a transfer may be associated with a greater chance at surviving the serious illness. However, there are ‘downsides’ or ‘risks’ associated with transfer to acute care hospitals. The transfer itself may be uncomfortable, difficult, and distressing because of the unfamiliar setting of the hospital. Compared to residents who stay at their home in long-term care, residents that go to hospital may develop additional complications, such as confusion and worsening memory, falls, new wounds and infections. Often, residents don’t return to their ‘baseline’ condition after going to hospital.

Because of these risks, some people choose to remain at the long-term care home to receive less aggressive care during times of serious illness. Long-term care homes can provide high quality palliative care because residents and families are familiar with the local staff, and the local staff know the needs of the long-term care resident. Therefore, in some situations, remaining at home in long-term care could be better for you or your loved one than transferring to hospital.

Remember, if you are making this decision on behalf of your loved one, please consider what your loved one would want if they knew of these risks, the alternative option of staying at home in long-term care, and their current medical condition.