The city’s Millionshchikova First Moscow Hospice hosted a conference whose participants, including Anna “Nyuta” Federmesser, Bishop Panteleimon in charge of the Orthodox Charity Service, Yulia Matveyeva, President of the Vera Charitable Foundation for Assisting Hospices, and Ingeborga Dapkunaite, Co-Chair of the Vera Foundation’s Board of Trustees, discussed the issues of improving the quality of palliative assistance. Moscow Mayor Sergei Sobyanin also attended the meeting.
“It appears that palliative care is among the most difficult and problematic types of medical assistance. Many years ago, federal law didn’t mention the concept. At that time, the state was not obliged to care for people who had several months or years to live. Unlike many other regions and cities in the world, Moscow started providing palliative care over 20 years ago,” Mr Sobyanin said.
Opened in 1994 under the initiative of British journalist Victor Zorza (1925-1966), one of the organisers of the global hospice movement, and by Dr Vera Millionshchikova (1942-2010), the Millionshchikova First Moscow Hospice is located at 10 Dovatora Street. Ms Millionshchikova headed the hospice for the first 16 years. Then Moscow Mayor Yury Luzhkov, Naina Yeltsin, the wife of Russian President Boris Yeltsin, former British Prime Minister Margaret Thatcher and Maria Vishnevskaya-Chubais, the wife of economist Anatoly Chubais, helped establish the hospice.
“I would like to thank Anna Federmesser’s mother, Vera Millionshchikova, for establishing this centre, which paved the way for regular palliative care in Moscow. In the past few years, we have started working more actively in this respect, and we have established a joint system of palliative care. I would like to thank Anna for addressing this issue. Her energy has largely helped us move ahead, and we have established a system of outpatient/visiting palliative care, approved clear regulations for providing such assistance, including the provision of pain-killers to patients. Many issues have been resolved, but many more remain; we still have a lot to do,” Mr Sobyanin added.
The hospice provides palliative care under the best international standards. Its experience was used to draft several Russian standards, regulatory documents and methods, currently being used across the country. In March 2017, the hospice became a subsidiary of the Moscow Multirole Centre for Palliative Care.
The hospice accommodates 30 adult city residents, mostly those from the Central Administrative Area and also cares for about 300 other people in their homes. In all, 95 percent of its patients are diagnosed with cancer.
Its doctors and nurses have treated 1,017 patients through 2017, visiting them at home 7,251 times; this includes 2,764 visits by doctors and 4,487 visits by nurses. Today, the hospice employs 80 people, including eight doctors and 32 nurses and paramedics. The hospice also trains palliative care personnel for all Russian regions.
In 2006, the hospice started providing non-medical assistance to patients and also involved volunteers from the Vera Foundation for Assisting Hospices. At least 500 people from this Foundation help the hospice each year. The Foundation is guided by the following motto: “If a person cannot be cured, this does not mean that he or she cannot be helped.” Volunteers have largely made it possible to dispel myths about hospices as institutions for lonely, abandoned and miserable people.
In 2014-2016, the Millionshchikova First Moscow Hospice received 72 pieces of medical equipment, including 32 oxygen units, nine pharmaceutical refrigerators, seven recirculation irradiators and five medical beds, with the city financing the purchases.
In 2013-2017, the hospice building, including the roof, utility mains and kitchen, was renovated, and the grounds were improved. Similar projects are also scheduled for 2018.
Palliative care in Moscow: love for humanity, compassion and help
Palliative care is provided to terminal patients, as well as to patients whose health usually results in premature death.
“The city and its medical clinics, as well as the city’s environment, see palliative care to be no less important than maternity care. The healthcare system keeps an eye on people from cradle to grave. The events of 1994 highlighted tremendous progress,” Ms Federmesser said.
In 2017, 28,000 patients with malignant tumours, serious irreversible brain strokes, chronic aggravated terminal conditions, degenerative diseases of the nervous system, multiple organ failure in the decompensation stage, heavy irreversible consequences of injuries and dementia, including Alzheimer’s disease, received palliative care.
“Lots of people, almost 60,000, need palliative care in this city,” Ms Federmesser added.
In 2015, the city established the Moscow Multirole Centre for Palliative Care in an effort to improve the quality of palliative care. The centre combined a multirole hospital, eight subsidiaries/hospices and district nurses for adults.
Today, 15 clinics with 1,127 beds provide inpatient palliative care. The list includes the following facilities:
- the Palliative Care Centre, including eight hospices, with 440 beds
- wards at general city hospitals with 687 beds, including 67 beds for children
In 2017, city hospitals and clinics provided palliative care to 12,593 adults and 361 children. The city also operates ten agencies employing nurses for adults, as well as four other agencies with nurses for children, including one private agency. Last year, agency personnel visited 10,282 adult patients 57,659 times at their homes, and they also visited 341 children 3,084 times.
Local clinics have 83 palliative care offices, including two at hospitals in the Troitsky and Novomoskovsky administrative areas. About 10,000 patients have been registered to date. The City Coordinating Centre for Palliative Care has been operating 24 hours a day since October 2017; email address: firstname.lastname@example.org telephone: + 7 (499) 940 1948.
The centre has the following functions:
- collecting initial data, keeping a register of palliative patients
- registering palliative patients with organisations providing palliative care and their subsidiaries
- transporting palliative patients if necessary
After a patient has been registered at the Coordinating Centre, a doctor will visit him or her within three working days. During primary examination, the doctor chooses an optimal palliative care option and determines the required frequency of visits. The number of visits is subject to change, depending on the supervision process. Today, the register keeps files on over 5,000 patients. In August 2017, the city passed additional legislation making it possible to issue pain-killers more quickly.
Doctors and district nurses act in line with standard protocols when visiting patients in their homes, including patients who require narcotic drugs and psychotropic substances. Patients being discharged from hospitals can receive prescription forms allowing them to obtain narcotic drugs and psychotropic substances for a period of up to five days.
In February 2017, the City Coordinating Centre for Palliative Care, eight hospices and a private hospice for children received their own pharmacies that can provide them with the required narcotic drugs and psychotropic substances.
In October 2017, 14 patients staying at welfare hospitals were transferred to those of the city healthcare system. And 243 people were transferred from medical organisations to welfare hospitals.
Employees of these organisations discuss palliative care issues and chronic pain syndrome treatment methods at workshops. Over 600 doctors attended 40 such workshops last year, and the programme will continue in 2018.
Vera Millionshchikova and her daughter Anna “Nyuta” Federmesser focused on a new palliative care principle, namely, close partnership between the city and public organisations providing this care. The city’s open hospices employ volunteers.
The city supports the Beacon House charity hospice for children, with its doctors and volunteers visiting and supporting over 400 terminally ill children. The renovated building, due to accommodate a hospital soon, is being fitted with modern equipment.