When the time comes, 90 percent of Canadians wish to die in their own bed, in their own home, according to a recent poll -- an increase of 5 percent over the last study.

Canadians so rarely agree on anything that when the majority concurs on a subject, that issue becomes all the more significant.

Although dying at home is preferred, 75 percent of deaths still take place in hospitals and long-term care homes. Two important underlying causes are a shortage of home-based palliative services and society's reluctance to treat death as an integral part of life.

Those in the hospice movement want to help Canadians facing their imminent death, or that of a loved one, by placing the emphasizes on living, not dying. After all, everyone, including an individual with a terminal illness, is living until the moment of death. Under hospice care, the final stage of life means the highest quality of life possible right up to the end. Typically, there is no fee for hospice services.

The Hospice Association of Ontario (HAO) explains it this way: "In medieval times, a hospice was a place of shelter or sanctuary for travelers, pilgrims and others. No journey in life is more difficult than the path followed by those suffering a life-threatening illness, so 'hospice' has now become a philosophy of care built around the quality of life for the dying and those that care for them."

Hospice care can take place in a variety of settings, from hospitals and long-term care facilities to specially-built residential hospices or the individual's home. Palliative care, which begins when curing is impossible, offers relief and comfort to the dying and their loved ones. Under the hospice movement, the quality of care involves emotional, psychological, physical, and spiritual support in the last phase of life and includes respite and bereavement services for family and friends.

"The hospice movement is committed to supporting individuals in their choice of setting and choice of care," said Tara Addis, HAO's Director of Hospice Relations and Programs, explaining that hospices complete the circle of care. "We hope to provide individuals across Canada [a] choice of where to die."

Since only an estimated 5 percent to 15 percent of Ontarians have access to hospice palliative care, HAO and its members are committed to continually expanding home-based services. Simultaneously, HAO is promoting the creation of a network of beautiful residential hospices offering home-away-from-home accommodation for the dying and home-like communal areas to share with visiting family and friends when a situation dictates the need for alternative shelter.

HAO has grown 1000 percent since its creation in 1987 -- from nine founding hospices to 93 hospice organizations today. Eighty-seven are home-based volunteer efforts which train selected volunteers to deliver services in the home and seven members are residential hospices, including Ottawa's Carpenter House Hospice and Toronto's Casey House and Hill House Hospices.

The population bulge represented by almost 10 million Baby Boomers (Canadians born between 1947 and 1966) means greater numbers of people at mature ages than ever before in history. Coupled with apparent increases in cancer, this may mean even more demand for palliative services and programs that enable Canadians to die at home or in home-like settings. In Ontario, almost 20 hospice organizations have started campaigns to develop residential hospices and HAO hopes to encourage more. Some hospice organizations can build because they have land and homes bequeathed to them.

To ensure "consistent, quality end-of-life care in humane and cost-effective Residential Hospice settings" and to promote building, HAO just released its province-wide HAO Community Residential Hospices Standards. This is a pre-emptive strategy to anticipate design and management problems and put widely-adopted standards in place to guide development of the network.

HAO already has standards and a 30-hour accreditation program in place for its Visiting Volunteer Home Hospice Program. Currently 13,300 volunteers dedicate 630,000 hours of service each year in more than 450 communities throughout Ontario -- hours that represent an investment of $6 million in local communities.

Addis suggests those looking for local Ontario hospice services or volunteering opportunities could start with HAO or its directory, the End of Life Information Service (1-800-349-3111) or the local Community Care Access agency.

Mark your 2005 calendars:

  • May 2-8: National Hospice Palliative Care Week celebrates the achievements of hospice palliative care in your community and throughout Canada under the all-inclusive theme "The Many Faces of Caregiving."
  • October 8: Celebrate the first annual World Hospice and Palliative Care Day!
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