Hospices

In the past few years, two family members who had terminal illnesses, and were nearing the end of their days, found comfort and support and a peaceful death in a residential hospice. One was in Richmond Hill, the other in Barrie. If I were in the same situation and wanted to end my life in a residential hospice in Toronto, could I do it? Probably not.

We don’t like thinking about death, much less planning for it, but I think it’s one of our jobs as seniors. If we don’t have a terminal illness right now, then we can think through our preferences calmly and dispassionately and then just tuck them away in case we need them later. That’s a lot better than having to make decisions, or having them made for us, in the midst of a crisis.

If we have an illness that is life-limiting and can no longer be treated, then we need palliative care. The focus of palliative care is on providing relief from the symptoms and stress of an illness, and improving the quality of life for the patient and family. It’s usually provided by an interdisciplinary care team, centred on the needs of the patient. In Ontario, palliative care is available in a number of settings: long term care homes, your own home, residential hospices, and some acute care hospitals. If you’re already in a long term care home, your care will just transition to palliative. If you’re in an acute care hospital, aggressive and invasive treatments may continue unless the hospital has a palliative care team to transfer you to. If you’re in your own home, you need family members or others to provide round-the-clock care, and you need funding to pay for substantial home care. Most of us won’t want to undergo aggressive hospital treatment. Many of us seniors live alone and don’t have a large support network or a lot of money for home care. So for us, the best option would be a bed in a residential hospice.

How many residential hospice beds do we have in Toronto? We have two hospices for the general public: Dorothy Ley (12 beds) and Kensington (10). There are also two hospices for special populations: Yee Hong PK Kwok, for Chinese and other Asian seniors (10), and Journey Home for the homeless (10). So that’s 42 beds for a population of 2.8 million. By way of comparison, Ottawa, with a population of 1,400,000, has 38 beds. Windsor, population 340,000, has 20. In Ontario. whether you can find a residential hospice bed is largely a question of postal code.

To make matters worse, Ontario’s funding formula for residential hospices covers just over 50% of their costs. Hospices have to make up the rest through endless fundraising, and they must rely heavily on volunteers. If donations go down, or the pool of volunteers shrinks – both of which have happened during the pandemic – then beds may be forced to close.

It is well known that specialized facilities such as residential hospices can provide better end-of-life experiences for patients and their families than acute care hospital beds do, and at a fraction of the cost. It’s time residential hospices got the support they deserve.