Oblastní charita
Třebíč

Center of Social and Health Services St. Zdislavy

The construction of the Center will create a unique offer in the Vysočina Region for comprehensive assistance to children and adults who benefit from the use of hospice, health and social services at the general and specialized level in their home environment. The project of the new background of the Center meets all the requirements for a
modern regional center of community health and social services for the entire region of the Třebíč region. As our population ages, the number of people who suffer from disabilities and health problems during their lifetime or at its end is growing. Being at home where one has built one's life is the best way to live well with a disability or illness. It is also support for the family, often multi-generational. We aim to support the life of a person with a disability, chronic illness and dying in the natural environment. We believe that illness must be prevented from destroying the life values of families during the life of their loved one and after his death.

The high quality of care is sustainable only with the development of a functional background. The center will serve
primarily as a base for doctors, nurses, caregivers, personal assistants, social workers, psychologists,
psychotherapists and other professionals who help people at home. Every year, the number of those who need to
use one of the health or social services increases, and the current premises no longer allow for an increase in
capacity. Demands in the areas of personnel, education, technical and logistics are increasing.
Home Hospice St. Zdislava demonstrated high quality and professionalism during a relatively short period of time
and joined the system of field services provided. The support of professionals is also essential for young families and
children, as it allows them to stay together at home during the most difficult moments. We are pleased that the model
of specialized palliative care, which is provided 24 hours a day, 7 days a week, allows us to live at home in a home
hospitalization of the same or greater quality than, for example, in a hospital. The operation is linked to other services, which can also prove to be of high quality.

An essential part of quality care is also maintaining the current model of cooperation of field services that provide
support to people in the health and social field. This Center is unique in the sense that the person interested in the
service will find specific help with the situation. The following facilities will have a common background in the Center
- Domácí hospic sv. Zdislavy, Lightening service of the Home Hospice of St. Zdislavy, Home Health Care, Charity
Care Service, Personal Assistance, Utility Rental and Training Center.

A great motivation for the establishment of the Center is the expansion of the offer and anchoring of education for
professionals and the general public. We are already an educational center of our region, we cooperate with the
Medical Faculty of Masaryk University in Brno and doctors preparing for certification in palliative medicine, we teach
medics and nurses, interns of the educational program of the Vysočina Region ELNEC internship. We provide
consultations to caregivers and health and social schools. The expansion and construction of the educational and
lecture room will enable all these activities to be carried out in a higher quality and professionalism.

The rental of compensatory aids is an integral part of the complex of services offered. Without well-chosen and
secured aids, it is not possible to take good care of a person at home.

The new Center would offer a significant shift in the availability and quality of care provided not only in the Třebíč
region, but also in the Vysočina Region.

Ladislav Kabelka, MD, PhD.

Introduction
The success of the development and establishment of specialized palliative care in the Czech Republic is due to many years of political, educational, and often voluntary work of many health professionals. I have been in this journey since 2003. In 2009, I was a founding member and then served eight years as chairman of the Czech Society for Palliative Medicine, Czech Medical Association of Jan Evangelista Purkyneˇ (CSPM). In 15 years, from 2005 to 2019, specialized palliative care has become an established part of Czech health care because of the work with professional societies, the public, government ministries, politics, regions of the country, and insurance companies.

The Timeline
2003, Austria—Salzburg—my first foreign course in palliative care (EPEC—Education for Physicians on End-of-Life Care). There I first met Professor Frank D. Ferris, who fundamentally influenced the development of Czech palliative medicine. He stayed in touch with me during the following years, and invited me to participate in the Leadership Development Initiative (LDI, 2009–2011, San Diego). I invited Dr. Ondrej Slama (scientific secretary of CSPM) to join me. In this two-year program, we learned from palliative care world leaders, were mentored by Professor Lucas Radbruch (chairman of the European Palliative Care Association at that time), and achieved a fundamental knowledge of palliative care in a public health context. This experience directed and motivated us to improve the Czech Society of Palliative Medicine.

Professors Radbruch and Ferris supported me in persuading the Czech Society of Palliative Medicine to host the World Palliative Care Congress in 2013 in Prague. It required more than a year of demanding work, including leadership and health-political work. I served as chairman of the local organizing committee of the Congress, with the aid of my assistant, Marta Duchonova, and with the support of Dr. Slama (scientific secretary of CSPM), Martina Spinkova. (founder of Home coming Prague), and members of CSPM committee. At the beginning of the congress, during the Minister of Health’s address, I realized how much we had shifted the perception of palliative care to be on equal footing with basic medical disciplines.

We needed to influence health insurance companies. We succeeded in convincing colleagues, politicians, payers, and the public that not only kindness, spirituality, and opioids were needed, but also much more sophisticated communication techniques, symptomatic treatments, precise knowledge of disease path, and the quality of care organization are required for quality palliative and hospice care. We conveyed that our subspecialty has rules, expertise, principles, and necessary organization/form. CSPM contributed significantly to this. In collaboration with my colleagues, the work achieved our goal. In shaping them, it also shaped me. When starting out in 2003, I could not have imagined how this journey would end.

Establishment of the Palliative Medicine Section SSLB ČLS JEP (1998)

SSLB has been a professional association of pain treatment physicians in the Czech Republic. The society has been a great influence for payers; for example, they ensured availability of opioids in the 1990s. At this time, the topic of palliative medicine was first named as an academic field in the Czech Republic. The key role was played by Professor MUDr. Jiri Vorlicek, CSc., highly influential in Czech medicine, then chairman of the Czech Society for Oncology, CLS JEP. I proposed Professor Vorlicek be appointed Honorary Chairman of the CSPM for his significant contributions to laying the foundations of specialized palliative care in 2013. In 1992–1993 Professor Vorlicek visited the English hospice system and realized that the hospice idea should be implemented in standard care in the Czech Republic. However, it took more than 25 years.

Establishment of a Common Discipline Palliative Medicine and Pain Treatment (2005)

Highlighting the fact that, in the Czech Republic, the ‘‘incurably ill exist, they are not properly cared for; improvement is possible, but requires education’’ was an essential first step. Professor Vorlicek convinced us, young and motivated pioneers, that formal recognition of a medical field, including establishment of a formal academic field, is a key step in gaining authority for a topic that other fields do not want, are afraid of, and avoid. This, of course, also applied to oncology. However, at that time it was just oncology to which palliative care was perceived to be germane. Even in cancer, it was only initially perceived as terminal hospice care (last hours, days, and weeks). I believe that our work for the next 10 years, also at the European level by the European Association for Palliative Care (EAPC), we have influenced oncology by becoming more interested in supportive care—and then in palliative care. Nevertheless, I also perceive the important role of the establishment of complex cancer centers in Czech Republic, under the influence of Professors Vorlicek and Dusek (www.biostatistika.cz/index-en.php) as enabling factors.

Read more in the link

MUDr. Ladislav Kabelka, Ph.D. - Domácí hospic Sv. Zdislavy, Třebíč

Paliativní medicína jako medicínský obor je také filosofií hodnot života s nemocí. Tímto článkem bych chtěl poděkovat všem, kteří byli a jsou (a budou) součástí procesu rozvoje specializované paliativní péče. Bez ní bychom nikdy nedokázali otevřeně komunikovat se státními orgány, pojišťovnami, kolegy jiných oborů. Bez specializované paliativní péče by paliativní péče, a ani její hospicová část nebyly součástí systému, a široká dostupnost by byla spíše science fiction. Za vznikem a rozvojem specializované paliativní péče v ČR stojí mnoho let zdravotně-politické, vzdělávací, velmi často dobrovolnické práce několika profesionálů. Byl jsem u toho od roku 2005, od roku 2009 v roli zakládajícího člena a poté 8 let předsedy České společnosti paliativní medicíny ČLS JEP(ČSPM). Rozdíl mezi situací specializované paliativní medicíny v letech 2004–2005, a nyní v roce 2020, je z mého pohledu zásadně v komplexním (odborné společnosti, veřejnost, ministerstva, politika, kraje, pojišťovny) přijetí faktu, že specializovaná paliativní péče je lékařským oborem.

První kontakt

V roce 2003 jsem odjel na svůj první zahraniční kurs paliativní péče, do Rakouska – Salcburku (EPEC – Education for physicians on End-of-Life care). Tam jsem poprvé potkal profesora Frank D. Ferrise, který zásadním způsobem ovlivnil rozvoj české paliativní medicíny. Zůstal se mnou v kontaktu i v následujících letech, přizval mně do projektu Leadership Development Initiative (LDI, 2009-2011 San Diego, USA), kam jsem podpořil také účast dr. Slámy. V tomto dvouletém programu nás leadership lídrů světové paliativní péče, mentorship s prof. Radbruchem (tehdy předsedou Evropské asociace pro paliativní péči, EAPC), a řada zásadních poznání stran paliativní péče v kontextu veřejného zdravotnictví

nasměřovala a motivovala k rozvoji ČSPM, jako zásadního hybatele ve změně přístupu k nevyléčitelně nemocným v ČR (založili jsme ji v roce 2009, byl jsem kolegy osloven k funkci předsedy, kterou jsem pak vykonával do roku 2017). Prof. Radbruch a prof. Ferris mně podpořili, abych přesvědčil tehdejší výbor ČSPM ke kandidatuře na Světový kongres paliativní péče. Tu se nám podařilo získat pro rok 2013 v Praze. Byl to více jak rok náročné, také zdravotně-politické práce, kterou jsme v lokálním organizačním výboru kongresu s asistentkou Martou Duchoňovou, s podporou dr. Slámy, Martiny Špinkové a členů tehdejšího výboru společnosti odvedli. Na úvod kongresu jsem si v přítomnosti přizvaného ministra zdravotnictví, pana docenta Hegera, uvědomil, nakolik se vnímání paliativní péče posunulo – byl položen základ pro postavení paliativní péče na stejnou úroveň se základními obory.

Byla to také doba, kdy jsme začali uvažovat o nutnosti více ovlivňovat zdravotní pojišťovny a jejich vnímání a postoj k tématu. Podařilo se kolegy, politiky, plátce péče i veřejnost přesvědčit, že nejen vlídnost, spiritualita a opioidy, ale také mnohem hlouběji propracované techniky komunikace, symptomové léčby, precizní znalost vývoje nemocí, a kvalitní organizace péče jsou tématem paliativní a hospicové péče, ve zdravotnictví i sociální péči. Že naše postupy mají svá pravidla, odbornost, principy i nutnou organizaci/formu.

Vznik Sekce paliativní medicíny Společnosti pro studium a léčbu bolesti ČLS JEP – poprvé se téma paliativní medicíny pojmenovalo v akademickém světě české medicíny. Klíčovou roli sehrál prof. MUDr. Jiří Vorlíček, CSc., tehdy předseda České onkologické společnosti ČLS JEP. Profesora Vorlíčka jsem v roce 2013 navrhl na jmenování čestným předsedou ČSPM, za jeho významné zásluhy o položení základů specializované paliativní péče v ČR.

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