Inspiring Impact with Nadine Persaud and Dr. Amit Arya

Cover art for Inspiring Impact mini-series. Image of Nadine and Amit

We’re back this year with the Inspiring Impact mini-series, a partnership between HIROC and AdvantAge Ontario to highlight the work of several presenters at their 2022 convention.

Show Summary

Nadine Persaud and Dr. Amit Arya have a deep passion for seniors’ care that extends beyond healthcare facilities with their community work, advocacy, education, and so much more. You’ll be able to catch them presenting alongside their colleague Dr. Naheed Dosani at the 2022 Advantage Ontario Convention with a session titled “Adopting a Specialist Palliative Care Program in Your Home.”

Again this year, HIROC and AdvantAge Ontario have come together to produce the Inspiring Impact podcast mini-series. This four-part series highlights several amazing presenters at the 2022 AdvantAge Ontario convention, and explores the innovation and passion at play in the long-term care sector.

In today’s episode, HIROC’s Marc Aiello and Philip De Souza speak with Nadine and Dr. Arya from Kensington Health in Toronto to gain their perspective on the current state of palliative care in Ontario, what they’ll be speaking about at the convention, and the future they envision for long-term care. 

Mentioned in this Episode


Imagine you could step inside the minds of Canada's healthcare leaders, glimpse their greatest fears, strongest drivers, and what makes them tick. Welcome to Healthcare Change Makers, a podcast where we talk to leaders about the joys and challenges of driving change and working with partners to create the safest health care system.

Marc Aiello: Welcome to Inspiring Impact, a special podcast series from HIROC and AdvantAge Ontario. From HIROC's communications and marketing, I'm Marc Aiello, joined by Philip De Souza.

In today's episode, we're sitting down with Nadine Persaud and Dr. Amit Arya, who specialize in palliative care and have a passion for senior care that extends beyond healthcare facilities, including advocacy, education, community work, and so much more. You'll be able to catch them presenting at the 2022 AdvantAge Ontario Convention, along with Dr. Naheed Dosani, with a session titled, Adopting a Specialist Palliative Care Program in Your Home.

Welcome to Healthcare Changemakers, Nadine and Dr. Arya. To begin, could you each tell us a bit about yourselves. Where you work and what you do?

Dr. Amit Arya: Hey everyone, thanks so much for inviting Nadine and I to speak on this podcast. So yeah, my name is Dr. Amit Arya, I'm a palliative care physician and I am currently the palliative care lead at Kensington Health in Toronto, which is a not for profit organization.

So I work alongside Nadine, and specifically work to provide palliative care consult services, palliative care specialist services in the 350 bed long-term care facility there. I also work in the hospital system and in palliative care clinics and home care through my role as a physician at the Freeman Center for Advancement of Palliative Care at North York General Hospital in Toronto.

In addition to this, I have faculty appointments at McMaster University as well as the University of Toronto. I also have a board position where I serve on the board of the Canadian Society of Palliative Care Physicians, and also I'm on the board of Canadian Doctors for Medicare as well. And I'm very happy to join this podcast recording today.

Nadine Persaud: So my name is Nadine Persaud and I'm the Senior Director of Client Services at the Kensington Health and the Executive Director of the Kensington Hospice. I've worked at Kensington Health now for over eight years. I also sit on the accreditation review panel for Hospice Palliative Care Ontario. I'm on the board of directors of the Hazel Burns Hospice, and I've been working in palliative care for the last 16 years.

I am a registered social worker psychotherapist by background, and I recently successfully defended my PhD in palliative care through Lancaster University in England.

Marc Aiello: That's great. And how did the both of you meet?

Nadine Persaud: Amit is hard not to meet because he's just like this rockstar where you just see him everywhere, whether it's on Twitter or on the news or whatever it is. So I think I was aware of Amit and his voice and his passion for palliative care, in particular long-term care.

So actually I think Hospice Palliative Care Ontario had chosen us to do some webinar series, and so we met through there. And then were further connected through Naheed, and we had just a random conversation about long-term care and our vision and what we would want to do. And then we thought there was an opportunity at Kensington to use this as a model home to create a sustainable model of palliative care and long-term care, and we hired Amit as our palliative care lead to help us carry out that project.

And I agree with everything that Nadine has said, it's really such an honor to work with the entire team at Kensington Health and to work under Nadine at that location as well. And we definitely have a vision about how Kensington Gardens long-term care facility can serve as a model. And we can definitely talk about that more as this podcast progresses, about how to improve palliative care in long-term care. And how to provide specialist palliative care services to residents in long-term care where they're at, rather than having them to go to other locations to seek that type of care, such as in a hospital setting.

Marc Aiello: So both of you will be speaking together at this year's AdvantAge Ontario Convention along with, as you mentioned Nadine, Dr. Naheed Dosani, in a session titled, Adopting a Specialist Palliative Care Program in Your Home. Are you able to share a bit about your session with us?

Dr. Amit Arya: Yeah, absolutely. So we'll be speaking just in general terms about this model of care. And this is really a shared care model where we, really once a week we provide specialist palliative care consults in long-term care based on referral from the primary care team. So that usually is the physician, the most responsible physician or often the attending nurse practitioner in long-term care. These consults once again are not for everyone with palliative care needs, because as we know the need for early integrated palliative care is quite broad. And in fact, one can speculate that the vast majority of residents in long-term care facilities and Ontario might benefit from an early integrated palliative care approach.

But once again, this is about looking for patients which have more complex needs, who are living in long-term care and sorry by patients, I met residents of course, and these are residents who might have complex or refractory symptoms such as pain or shortness of breath. There might be sort of some complexity around goals of care discussions and having that palliative care consultant who can come to the long-term care facility and provide recommendation to the primary care team and also build capacity in the primary care team for them to improve their own palliative skillset will be very helpful. So this project, I'll just summarize my comments here by saying that we've started this project for over a year now at Kensington Gardens and we'll be sharing sort of real examples of success stories and hopefully providing some inspiration and some tips as to how other long-term care facilities in Ontario can also build a similar model of care to improve palliative care.

Nadine Persaud: Well, I think the pandemic kind of highlight it, a problem that we already knew existed and that was that a long-term care needs to be revamped. And I think the system was built broken. And one of the biggest things is that long-term care is changing and everything that happens in long-term care hasn't kept up with acuity levels rising and us serving people who are much frailer and much sicker. So a lot of what we do is palliative care and long-term care. And people tend to not understand that. They tend to think that long-term care is separate from palliative care when they are one. And I think our presentation is really about the ability to view palliative care as an integral part of long-term care and have people recognize that.

I think even staff in long-term care don't really understand that palliative care is what we do. They often say to us, "Oh, well, no, that's what you do at the hospice next door." And it's like, "Well, we have almost the same amount of people die in our long-term care home every year that we have in our hospice." So there's a big philosophical shift that has to happen in terms of what is in long-term care. And we hope that our presentation kind of highlights the need for that.

Marc Aiello: So what makes you so passionate about this project in particular?

Nadine Persaud: So I think when I started in my career, I was in community palliative care. So supporting people through community hospices who really wanted to stay at home. And I always said, I will never work in long-term care because you hear about long term-care. You go into long-term care, you see people lined up at the nursing station. It often smells bad. And I was like, "I don't want to be anywhere near long-term care." And then I came to Kensington and I was like, "It's different. This doesn't feel like long-term care. This actually feels like a home." And it's these misconceptions that you hear in the media about, what long-term care is. I was like, this isn't actually happening in many long-term care homes. Yes, there are horror stories, but there are also other stories of meaning and purpose that's happening every single day.

So I transitioned my career from community palliative care to really understand long-term care and how we can improve palliative care within long-term care because people that are dying in long-term care deserve to die with dignity. They deserve to die at home. They deserve to die around the people that they love the most with staff that know them the best. And I think that one of the things that binds Amit and Naheed and I, is our passion for the ability to care for people who are older, older adults, seniors, which is often a missed population, which is often people just think, "Oh, they've already lived. You're 90 something years old. Why does it matter?" And everybody matters.

And I think that understanding that palliative care is so important in long-term care drives our passion to ensure that people live well until they die. And at Kensington, our slogan is giving new meaning to community care. Because I think that if you look at the news, most of my misconceptions of long-term care are still there today. And when you step into homes like Kensington, and I don't think it's unique to Kensington, there are other homes like Kensington as well, where beautiful moments are happening every day. We see such powerful moments. We learn stories of individuals that really make it an honor for us to be able to care for them. And I think when we learn the essence of each person that we care for, that drives our passion. And that's what drives that inner fuel of resilience within each of us to continue to do this work every single day.

Dr. Amit Arya: Yeah. So of course I agree with, everything that Nadine has said so beautifully and so accurately, in terms of what drives my passion, I can also take it back to how I was first exposed to long-term care. And that was when I was doing comprehensive family medicine. I believe it was back in 2014 and I've been working in long-term care ever since. But I really was working in... And I'll give you sort of an example of what I've seen. So I was responsible for caring for 32 residents at that time. And I just was shocked because it wasn't presented to me in this way. And I think, as Nadine said, a lot of people are unaware of this, the complexity and acuity of care and actually the skillset needed to care for those 32 residents was very high.

And I remember being there for example, one full day, I remember I used to go one full Monday and spend the entire day there because there was so much work and so much time was needed in order to care for the residents, help the health workers in order to make sure that they knew that they were doing and had proper support and also call the family members. And I used to go once again, a full day, Monday and Thursday, and sometimes even Saturday as well, because once again, the needs of the residents were so high.

And what were those needs around? It was very common that, maybe once a week or maybe once every two weeks somebody would have a critical infection. And there would be a question about whether to send someone to the hospital or not. There would be another person who would start to have more significant swallowing difficulties. And there would be a third resident who would suffer a fall. A lot of the families were extremely burnt out and were in crisis by the time their loved ones arrived in long-term care.

And I think my experience has really taught me that we need a lot more recognition about the palliative care needs as Nadine has spoken about, in long-term care, because this is just the norm, complexity and acuity is rising. And unfortunately long-term care is under-resourced and understaffed. We know that from statistics, from the Canadian Institute for Health Information, only 6% of residents in Canada, and this is from a few years ago, but I think still very, very relevant because it's a problem that has not been addressed. 6% of residents have been documented as have having received a palliative care approach, in the last year of life.

And of course we've also wanted to outline, as Nadine has also talked about that palliative care, a lot of the times in long-term care facilities is thought of as just end-of-life care, but that is inappropriate. Palliative care is not synonymous with end-of-life care. And the reason for that is that the 21st century model of palliative care and the new standard of palliative care, which we should all be thinking about across all areas of the healthcare system is that palliative care should start early and it should start in a timely fashion. And the reason for that is because suffering does not just occur at the end of life. Suffering often occur is a lot earlier. And that is something that is very reflective of our experience, that there is a lot of preventable suffering, unfortunately, that is happening in long-term care facilities. And that preventable suffering unfortunately was exacerbated during the COVID-19 pandemic.

But we need to make sure that there is a lot more resources, a lot more education provided, a lot more staffing to support palliative care in long-term care. And part of that support that we will highlight based on our experiences of working at Kensington Gardens will be also about having palliative care specialist support in long-term care, which is something that is present in a few long-term care facilities, but is definitely not the norm. And it should be the norm because once again, people should have access to the right care in the right place and at the right time.

Marc Aiello: Yeah. And you mentioned that, this misconception that palliative care is end-of-life and it's not, are there other major misconceptions that you feel people have about palliative care that is something that you need to address or people need to address every day?

Dr. Amit Arya: So I think Nadine and I could speak for a while about some of the misconceptions. I think that's a good question though. Definitely that's probably the number one misconception that I encounter, that palliative care is just end-of-life care and very often that results in delayed referral to palliative care services, or often a fear of talking about palliative care early on in the disease trajectory, which is really when we should be thinking about palliative care. And I mentioned the early integrated palliative care approach. And I'll explain. So we talked about early palliative care and why that's important, I'll explain what integrated means.

So, a second myth that we often encounter is that palliative care means giving up on other treatments. It means that you can't go to hospital. It means that you can no longer have life prolonging treatments. And that is absolutely not true. So palliative care can and should be integrated along with other life prolonging treatments. It simply means that there's proper care for the whole person. And it means that we're focusing on, not just sort of one organ or one disease, but we're focusing on any type of physical sources of suffering, but also emotional, psychological, social, spiritual, and financial causes of suffering as well. And we're looking at the resident, not just as treating them, but also looking at treating their caregivers, their health workers to making sure that really once again, whole person and also whole family and community centered care is provided equitably. So once again, that's another myth that care means giving up on all life prolonging treatments.

A third thing that we probably encounter is that palliative care means that it's equivalent to hasten death. And that's actually not true. Of course, we work very closely together with our colleagues who provide hasten death or medical assistance in dying, but the two are not equivalent. And once again, palliative care is something that is applicable for the vast majority of us and many of us will need palliative care as we get older. And once again, the early integrated palliative care approach is very important.

Maybe, a couple of other myths that I can speak to is oftentimes people think palliative care is only needed for an illness like cancer. And in a way that is reflected in our terminology where we kind of think about metastatic cancer and right away, we think about someone who maybe needs palliative care, or somebody has a terminal illness, but often we see the word chronic illness used for other equally terminal illnesses with a lot of suffering like dementia or congestive heart failure, or COPD. And I think that, reflects our stigma around these illnesses where we don't recognize that dementia is actually a terminal illness, is actually a life limiting illness, which dramatically affects quality of life and brings with it a big burden of suffering, not just for the resident, but often for their family members as well. And that needs to be addressed by a palliative care approach, and it is often neglected in our system.

So yeah, once again, palliative care is not just end-of-life care, palliative care is not hasten death, palliative care is not just for cancer. And as I mentioned, palliative care does not mean giving up on life prolonging treatments. And maybe the last thing I can say is that often when people hear palliative care, they think it's a location, or it's a place that you go, like a palliative care unit or a hospice. And while of course those locations are focused just on end-of-life care, palliative care is not a specific place or a location, but rather it's a specialized type of care that's provided in an interdisciplinary team. So it's not just provided by the physician or the nurse, but it's actually provided by a whole team that can support you, and should it be supporting you regardless of where you're living and this type of care should be provided across the healthcare system.

Marc Aiello: Yeah. And as soon as we address and dispel those type of stigmas, people can get the care that they truly need. And I wanted to ask Nadine, you mentioned earlier that you've had these moments, you get to hear incredible stories from the families of residents, from residents themselves. Is there a memorable one that you have in mind, as I'm asking this question, is there one that comes to mind that you'd be open to sharing?

Nadine Persaud: I think we could write a book on the amount of meaningful moments that we have in long-term care. I think that it's hard to think of it on the spot, the particular story, but I think we had a resident here and he ran our resident council for many years and he had a real passion for being a voice for residents in long-term care. And he was with us for quite some time. And after he had died, his brother said that he had expressed to him that these were the best years of his life, living in long-term care. And I think that's powerful me for me and it stands in out because often, we don't age and think, "I can't wait to retire and go to long-term care," or, "I can't wait to age and go to long-term care." That's not what life is about. People don't think.

And often people think if you move into a long-term care home, then life is over. And for many people that we see life actually starts. Because what happens is our healthcare system isn't equipped to allow people to live at home for as long as they can. We don't have a proper infrastructure for home care. And we hope that will be the case in the years to come, but that's not the reality. And we see that when people actually come to long-term care, their family members are able to be a mother or a father or a sister or a brother because they no longer are a pseudo physician or a pseudo PSW or a pseudo nurse. They're actually able to spend meaningful moments at the bedside, creating memories of love of care.

Whether they're taking part in our activities. Every year at the gardens, we have what we call a tree trimming, where the residents come down and we have a tree and we decorate the tree and we have someone playing a harp and we sing songs. And this was the first year since the pandemic where we were able to do. It looked different, but we were able to do it. And one of the residents came down and he said, "I am so happy I came down because it feels like there's life in this place again." And we saw what happened with the pandemic, with restrictions on visitation, with restrictions on human touch, which we know is the most important part of palliative care.

And I think that these meaningful moments that we create through celebrating people's hundreds birthdays, or doing legacy work, we had one woman here who was one of our younger residents, and she was living with a neuromuscular disease where she could very barely speak. And with our music therapist, she wrote a song for her two young children, but she did it differently. She didn't want this song to be sung to them after she had died, she wanted to be done on while she was still alive. So our music therapist took her words and put music to it. And they sat in our multipurpose room and she sang it to her children while the resident was there. And it was one of the most powerful experiences because they got to listen to what their mother would want to say to them while she was still present.

And often what we say is that, we wait for a funeral to tell people how much they mean to us when those are the speeches that we should be giving at birthday parties. So when we had somebody recently who had a medical assistance in dying, we did just that, we celebrated her birthday, her hundredth birthday early, and everything that people would've said at her funeral, they said it that birthday. And I think those are moments that we create in long-term care. I think those are moments that we create that give meaning and purpose.

Those are moments that we call small victories, where we can look back at a really, really tough situation and we can say, "Yeah, our mom died in a long-term care home when we really wanted her to die at home, but remember the time when..." And I think that's what we strive for every day, we strive to create those moments. We strive to dispel these myths as Amit spoke about, in about palliative care and long-term care. And we do those every single day. And I think that long-term care is getting a really bad press right now. And I think, some of it is needed because we know that things were wrong with the pandemic. And we know that there was a lot of suffering, but we also know that there is a lot of beautiful small victories happening every single day. And we need to highlight those more often.

Marc Aiello: Gosh, that's so of powerful. I'm getting a bit of emotion [inaudible 00:22:11], just hearing that incredible. Just your words about, yeah, saying it while people are still around and showing that how appreciated they are. And so for this next question, I just love to hear about your vision, what you both would like to see about the future of seniors care.

Dr. Amit Arya: Yeah. So I can, of course reiterate a lot of what Nadine has said. I think that the COVID-19 pandemic has also, once again, highlighted preexisting inequities and major failings in our elder care system, and really now is the time for governments of all parties and all levels to come together and really fix and overhaul this broken system. Right now, I would highlight that, we are at a crisis point and this crisis is only going to get worse and not better because of the fact that our largest age cohort, baby boomers turns 75 in 2021. So there's going to be actually a lot more people here in Canada who are going to need these services and are going to need much better elder care services.

So if I had to think about a few things that can be done right now and what should be done across the system, I would start with, as Nadine mentioned also, and something that I believe in a lot is around home care. I truly believe that we have to reform and think about the way we even think about the term long-term care here in Canada, it's associated with institutionalization and being in a facility. And of course there's many beautiful moments of, and very impactful life moments that I've also seen in long-term care facilities as well, but let's face it. The vast majority of older adults do not want to end up in a long-term care facility. And I can tell you very honestly that in spite of the fact that once again, good care is provided in many long-term care facilities, people don't want to go there in the first place. And we have to respect that wish, people want to stay in their own homes.

And in fact, I was reading a survey recently that said that about 89% of seniors in Ontario, once again, want to stay in their own homes. But Canada grossly underspends on home care and grossly underspends on these community care services, which include long-term care and in home care. So just to give our listeners a comparison, the Netherlands spent 3.7% of public spending on this community care services, which includes long-term care facilities and home care, 3.7% of public spending went towards that. Denmark spent 2.5%, but Canada only spends 1.3% of this pocket of money on these community care services. So that's obviously Canada's grossly underspending and we cannot get through this via austerity measures for older adults. That's essentially what this is.

And I'll add that the proportion of spending is also incorrectly spent, it's spent vast majority on long-term care facilities, and we simply will not be able to just build our way out of this elder care crisis, and it's going to be very expensive of course, to do that because it will require more and more of these buildings, which will need capital expenditures. So this is actually once again, going to be very expensive. And I'll share with you the statistic that once again, Canada only spent 1.3% of their GDP on publicly funded community care services is which includes long-term care and home care. But out of that 1.3%, just 0.2% was spent on home care. So very small proportion. So once again, we need to be spending probably the majority of that money on home care. It'll be a lot more cheaper for the taxpayer, and it'll be much better for the care of older adults. So that's one thing, spending more money on home care.

Dr. Amit Arya: Secondly, we have a health and human resources crisis across our elder care system where we simply don't have enough skilled health workers to look after older adults at this time. So we need to hire and recruit and train many, many more health workers right away, and we need to improve their working conditions.

And to give you an example, a little bit about the disparity that exist in long-term care facilities compared to other areas of the healthcare system, we were talking about Kensington Gardens, which of course is a very, very good long-term care facility in Ontario. And I'm sure Nadine would agree, but we're very privileged to be working there. And there I've seen, and correct me if I'm wrong Nadine, there's one nurse for 25 residents in the day, which is actually higher than almost any other long-term care facility I've stepped foot in the province. It's usually maybe 1:30 or 1:32, but in the hospice next door, the ratio is 1:5. So it's not possible for long-term care to compete with a level of care that is provided in the hospice.

And of course the nurses and all the frontline staff in long-term care, many of them are extremely skilled, very dedicated, very hardworking and caring, but it's once again, just simply not possible because there's not enough health workers. So we need to kind of address this crisis and realize that we need to recruit and train health workers, which is going to take years at this point in time, even if we start now, but better to start now, rather than later.

And the third point that I would definitely say, once again, we cannot have austerity measures when it comes to the care of older adults, but we have to make sure that we also do not have greed when it comes to the care of older adults. And we've seen how, private operators of long-term care facilities. And also there's of course, private companies, which are home care agencies can affect the wellbeing of not just the health workers, but also of the patients and the residents that are being looked after. So that's actually something which is, are very important.

And I'll add one last point that I hope specifically with long-term care, we know that because of understaffing and because of turnover of health workers, which is, happening on a system wide level, often the care that is provided is task based where there's sort of a checklist where you see if someone has been bathed or someone has been fed and nourished on time, or they've been taken for their walk. But of course, life is more than a checklist. And we need to make sure, as as Nadine spoke about many more of those opportunities to provide hope, meaning, and joy to people, provide more recreational activities, more interaction with nature, there needs to be enough staff in these long-term care facilities. So that can just be the norm across the system and care is individualized rather than ration.

Nadine Persaud: I think we look for a world where there was equitable care for everybody that wants care. So we know it's just not about access, it's about how everybody has access. We know the people who are structurally vulnerable are less likely to have access to long-term care and basic palliative care, which is a human, right. So I hope for a world where people get care based on their needs, as opposed to everything else that people get care for. I hope that as opposed to just talking about equality and a everybody getting the same care at the same time, in the same place, I'm expecting everybody to wear the same shoes. I hope that people get the shoes that fit them based on where they're at and where they need to be. I hope that people are able to live where they want to live and die where they want to die, not coming into us in a crisis.

It's unusual for me to get an application where it's like somebody who's lived this wholesome life and is just ready to come into long-term care and enjoy their golden years, never happens. We see most of our applications are people who are in crisis with comorbidities, who are living with many other issues outside of just medical issues. Who've had horror stories within the healthcare system. And now when you hear these horror stories, it's just like, "Oh, another one," it doesn't even shock you anymore.

I see that the profile of people moving into long-term care is changing. We're seeing a lot of younger people, a lot of people who are structurally vulnerable, a lot of people with mental health issues, which I also think is another issue. I don't think that long-term care homes are equipped to support people who are living with mental health illness. I think that dementia it's one illness that we're learning how to support, but I think mental health brings a whole other gamut of training and expertise that's needing in long-term care. And I don't think that we're equipped to deal with that. I think we're seeing a lot of younger people.

So I hope that we're able to create a system that is flexible, we're able to create a system that is equitable, and we're able to create a system that is built around the people that it supports, not the other way around, which is what we've seen and is why we didn't do so well in the pandemic.

Kensington has one of the longest wait lists in Toronto, and it could be something that gives us a feather in our cap to say we're the best, but I don't actually think it's a good thing. I don't think that the fact that we have thousands of people waiting on a wait list for upwards of four years to get a long-term care bed is a good thing.

I hope that people don't have to be in a hospital bed waiting for long-term care. I hope that people don't have to be at home, coming in and living in long-term care for a really short time because they are at the end of their illness. I hope that people get care earlier on. I hope that palliative care is understood to be a holistic approach to care and not just focused on medical care, that it looks at whole person care, that it looks at the psychosocial, the spiritual, the mental, and the emotional, and really focuses on how we deal with things like existential distress, how we adjust grief and loss, because I think we don't talk about grief enough in long-term care. And we don't talk about loss enough in long-term care.

I hope that we're better able to support healthcare workers. We've seen that in this pandemic, it's not the big, huge CEOs and all of these lawyers that got us through the pandemic. It's the PSWs, it's the housekeepers, it's the TTC drivers. It's the people that, when we often look at hierarchies, the people that are on the lower end of this hierarchy that our society has created are the people that are the true heroes, that have carried us through this pandemic. So I hope we recognize that. I hope that this term hero that we're using so loosely right now really puts value to what people have done to get us to where we are today with this pandemic. And I hope we're able to value everybody for their support and really create a system that is for us.

Philip De Souza: You definitely provided our listeners with a very insightful lens, which I'm sure many listeners wouldn't have even considered some of the items you brought up, and I really appreciate you doing so. And I noticed you guys wear lots of hats, when you mentioned all the things you do. And is there any advice you would give, like you can give, for example, the three of us today, Michelle, Marc, and I, and anyone else listening on how you navigate that and still maintain the amazing passion, I can hear it in your voice.

Nadine Persaud: I think the key word is passion. And I think that you can wear multiple hats and you can wear one hat and it doesn't matter how many hats you wear, as long as you have passion. I think that's what drives your ability to want to do more. So I think that as long as you remember what you stand for, I think that we all need to have a strong voice and it's very easy to get discouraged, and it's very easy to think, how can I ever overcome this? Both of us, Amit and I have spent years in school. I think that I'm in grade 25 right now. And when I think back to the way the education system is set up, it's set up for us to be heroes, to make a difference, to get into the real world and actually take everything that we've learned.

And you get into the real, and you realize that there's legislation and there's systematic racism and there's sexism and there's everything else. And you're like, "Whoa, I didn't think it would be like this. I thought that I just get all this education and I change the world." And you realize that's not what's going to happen. So I think that you have to be able to say, "Yeah, there's going to be really tough times and we've got to weather a lot of storms, but there going to be really good times." And I think this podcast is a really good example of opening up reflective space for us to be able to talk about some of these issues. And I think when we open up reflective space, we're able to reach communities and populations that we probably would've never reached. And I think that the work that you guys are doing is so incredible because this is what we need. We need to have more open candid conversations about the reality of what's happening. And when we're able to open that up, we're going to be able to see a lot more change.

Marc Aiello:
You've just listened to our interview with Nadine Persaud and Dr. Amit Arya, palliative care specialist and speakers at this year's AdvantAge Ontario Convention. This episode is part of our Inspiring Impact series for 2022 in partnership with AdvantAge Ontario. If you've liked what you've heard, please leave us a review and don't forget to hit the subscribe button, so you'll be notified when new episodes are released. For more information about HIROC and to listen to other episodes of Healthcare Changemakers, including the Inspiring Impact series, please visit and favor the show on your prefer podcasting app. Thank you for listening.

Thank you for listening. You can hear more episodes of Healthcare Change Makers on our website and on your favourite podcasting apps. If you like what you hear, please rate us or post a review. Healthcare Change Makers is recorded by HIROC's Communications and Marketing team and produced by Podfly Productions. Follow us on Twitter at @hirocgroup or email us at We'd love to hear from you.