PART 7 — The Palliative Care Hijack How Preventable Decline Is Being Framed as “End-of-Life”

⭐ PART 7 — The Palliative Care Hijack

How Preventable Decline Is Being Framed as “End-of-Life”

By Canadian Citizens Journal

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⭐ Palliative Care Was Meant to Protect People — Now It Is Being Used to Redirect Them

Palliative care in Canada was built on a simple principle:

When a person is approaching the natural end of life, their comfort becomes the priority.

But over the past decade — and especially after 2020 — the meaning of “palliative” has quietly shifted inside long-term care homes.

Residents are increasingly being classified as palliative not because they are dying, but because the system cannot provide the care required to keep them stable.

When chronic understaffing, poor nutrition, isolation, unmet medical needs, preventable infections, or environmental neglect push a resident into rapid decline…
the system now calls that “end-of-life.”

This is the core of the palliative care hijack.

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⭐ The New Pipeline: From Decline → “Palliative” → MAiD

Families are told their loved one is “failing to thrive.”
Workers are told “there’s nothing more we can do.”
The charts frame decline as irreversible.

But in countless cases, the suffering that leads to this classification is produced by:
• understaffing
• nutritional decline
• rushed feeding
• preventable infections
• poor hydration
• cold rooms
• mobility loss from lack of support
• delayed medical intervention
• untreated pain
• isolation

When a system creates suffering and then labels that suffering “palliative,” it becomes a pipeline — one that now intersects directly with MAiD.

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⭐ The Collapse of Clinical Staffing: When Nurses Are Overloaded and PSWs Carry the Weight

One of the most overlooked drivers of premature palliative classification is the collapse of clinical staffing inside long-term care.

In many facilities, one nurse is responsible for:
• all medications
• multiple floors or buildings
• supervising all PSWs
• emergency responses
• charting, assessments, and care plans
• contacting physicians
• managing unstable medical conditions
• handling referrals and paperwork
• responding to behaviors and crises

No nurse can safely handle that workload.
The system knows it — and does nothing.

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⭐ The “Coverage PSW”: One Worker Doing the Job of Two Buildings

To compensate for impossible nurse workloads, many facilities rely on a single multi-building PSW who is expected to:

In one building:
• complete full med passes
• answer all call bells
• assist with feeding and baths
• respond to emergencies

Then move to the other building to:
• finish second-floor medications
• support the already overwhelmed nurse
• respond to additional call bells
• help manage behaviors
• fill gaps in personal care

This PSW becomes:
• extra care staff
• extra medication staff
• behavioral support
• and emergency backup

This role is unsafe — yet it has become standard practice.

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⭐ When the Nurse Calls In Sick, the Entire System Falls Apart

If the only nurse is absent, medication duties automatically fall onto PSWs, even when they are already short-staffed.

This forces PSWs to perform:
• med passes
• personal care
• call responses
• meal service
• emergencies
• supervision across buildings

PSWs are not trained or licensed for:
• interpreting medication changes
• managing drug interactions
• handling unstable conditions
• triaging multiple crises

This predictable overload leads to medication errors, especially after:
• dose changes
• new prescriptions
• behavioral medication adjustments
• complex drug regimens in dementia residents

The errors are not the fault of staff —
they are the result of a system using PSWs as substitute nurses.

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⭐ Chronic Stress: The Emotional Weight Workers Carry

Workers inside LTC live with daily emotional strain:
• fear of missing meds
• fear of resident falls
• fear of being blamed for systemic failures
• guilt for not having enough time
• exhaustion
• burnout
• moral injury from preventable suffering

This is not a workplace challenge —
it is a chronic emergency affecting the entire sector.

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⭐ How Staffing Collapse Leads to Premature “Palliative” Labeling

When staffing is this unstable, residents do not receive:
• early intervention
• timely assessments
• medication reviews
• proper feeding
• hydration
• safe mobility support
• behavioral monitoring
• ongoing medical evaluation

When preventable decline goes untreated long enough, the resident is eventually described as “palliative.”

But the truth is:

The system did not run out of treatments.
The system ran out of staff.

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⭐ Palliative Care Used to Mean Comfort — Now It Often Means “We Cannot Manage Care”

Workers across the country report residents being placed on palliative pathways because:
• they were losing weight
• they were dehydrated
• they were too weak to walk
• they had repeated infections
• they were emotionally withdrawn
• they were not eating the food
• they were too cold
• they were not stable medically
• the facility lacked resources to maintain them

These are not natural end-of-life symptoms.
They are system-produced decline.

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⭐ Once Labeled Palliative, MAiD Conversations Begin

Once a resident is classified as palliative, they are placed in a medical category that now overlaps significantly with MAiD criteria.

Families who refuse MAiD are pressured.
Families who never considered MAiD are suddenly introduced to it.
Workers are instructed to provide “information.”
Residents often feel they are a burden.

The sequence has become disturbingly predictable:

System neglect → preventable decline → palliative label → MAiD eligibility.

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⭐ Palliative Care Has Been Hijacked

What was meant to ensure peace and dignity has become a form of triage — a way for overwhelmed systems to manage decline they helped create.

This chapter exposes what families and workers have long suspected:

Palliative care is no longer reserved for those who are genuinely dying.
It is increasingly used as a management tool inside a collapsing long-term care system — and it feeds directly into MAiD pathways.