Admission request procedure for the Vaudreuil-Soulanges Palliative Care Residence Foundation

The Vaudreuil-Soulanges Palliative Care Residence is accessible to all persons in need of palliative care, regardless of age:

  • who reside within the area covered by the Vaudreuil-Soulanges CSSS and immediate surroundings or who have a loved one residing in the area.
  • who are hospitalized in the Suroît Regional Hospital or the Hawksbury Hospital
  • who are transferred from the waiting list of the West Island Palliative Care Residence

Admission Criteria

  • persons suffering from an incurable disease which is progressing and is now in terminal phase, with an estimated life expectancy of less than 3 months
  • persons who have been informed that all available treatments designed to cure or to modify the course of the illness are no longer under consideration
  • persons who accept and freely choose to be admitted to the Palliative Care Residence and who have knowingly and voluntarily signed the consent form (the consent form can be signed by a legal guardian or designated representative in the event the patient is unable to consent or sign, due to illness)


A copy of the required referral documentation is to be faxed to the Vaudreuil-Soulanges Palliative Care Residence, to the attention of the Director of Care at 450-202-2205:

  • Admission Request Form filled out by a health care professional and the attending physician or the family physician
  • Admission Request forms used by the “Mécanisme d’accès à l’hébergement du Grand Suroît” or the West Island Palliative Care Residence can be forwarded
  • Signed Consent Form (mandatory)
  • Summary Report specifying the patient’s present state of health and functional assessment
  • The following documents, required to analyse the admission request, if available :
    • pharmacological profile as prepared by the hospital or community pharmacist
    • multi-clientele assessment tool (OEMC)
    • data collection, nursing care plan and/or the therapeutic nursing plan
    • summary of most recent hospitalizations
    • pertinent consultation notes or reports
    • histopathology reports
    • recent medical imagery reports
    • recent lab reports

When a bed is available

The PCR Admissions Committee will evaluate the admission requests based upon the admission criteria.

The Vaudreuil-Soulanges Palliative Care Residence Director of Care will advise the Case Manager when a bed becomes available for a patient. Confirmation of Consent to Admission must be given within a reasonable time, within 2 and 4 hours.

Prior to the admission at the Palliative Residence, the Case Manager must:

  • inform the Director of Care as to the latest status of the patient’s health as well as equipment needs to be transferred with the patient or expected to be provided by the Palliative Care Residence (therapeutic mattress, O2 concentrator, morphine pump, etc…)
  •  ensure the patient brings his medication from home
  •  inform the patient’s family/attending physician of the transfer to the Vaudreuil-Soulanges Palliative Care Residence
  • inform the Palliative Care Residence in the event the patient dies prior to the transfer

Initially, the patient’s admission will be scheduled for a weekday. However, admissions can occur on weekends and statutory holidays depending on bed availability and personnel resources.

The transfer of a patient back home, to a hospital or a public or private long term care center will take place according to the admission procedures set forth by such institutions.

Admission forms:

Admission Request Procedure

Pre-admission Consent Form

Admission Request