Francine Brunet and her daughter Josee sit comfortably beside a fireplace in the Dorothy Ley hospice in Etobicoke, Ont. Volunteers are making muffins and soup nearby.
鈥淲hen we arrived here, and when I saw it, I said 鈥楾hank god, thank god鈥�!鈥� Josee said.
鈥淭his is what dying should look like,鈥� they told us.
Francine has end-stage lung cancer that has spread to the liver. Josee could no longer care for her mother at home and applied for a room at the hospice. She鈥檚 been in care suite No. 9 for a week.
Volunteers make special meals and play beautiful music. Francine鈥檚 room has a bright window and a vibrant handmade quilt hangs on the wall beside her family photos. Francine鈥檚 every need is attended to -- all with a simple ring of a bell.
鈥淭hey ask, 鈥榳hat would you like for dinner?鈥欌�� says Josee with a smile. All her mother鈥檚 medical needs are tended to by palliative care doctors and nurses. Francine had told them: 鈥淚 don鈥檛 want any pain.鈥�
It鈥檚 a stark difference, they say, to the recent death of Francine's husband from a brain tumour. He died in a hospital. The family says it was harsh and impersonal. 鈥淣o, he didn鈥檛 have palliative care鈥� says Josee. 鈥淚f he had this, it would have been beautiful,鈥� says Francine.
The goal of the hospice and palliative care is to minimize the suffering of the patients and their families and to make the best of their last days. The average stay here is 21 days, though some patients have stayed longer.
Zaynep Onen, vice-president of the Dorothy Ley Hospice in Mississauga, says staff talk to people and ask what they want to accomplish in this period.
鈥淲hat do you want your end of life to be?鈥� Onen says they ask. 鈥淭hings you haven鈥檛 done yet, people you want to talk to, conversations you haven鈥檛 had. A hospice asks: 鈥榃hat is it you want?鈥� We talk to the individual and ask them: 鈥榃hat do you want to accomplish in this period?鈥欌��
For one client, it was a wish to ride on a pontoon boat. And the volunteers arranged that.
The Dorothy Ley Hospice provides palliative care for about 180 people in its residence each year, and delivers palliative care at home to some 2,300 others in western the western Toronto area.
A report by the Canadian Cancer Society says half of those with terminal illnesses never get this high quality end-of-life care.
Gabriel Miller, a co-author of the Canadian Cancer Society , says one in two cancer deaths are happening in emergency or acute care hospitals. 鈥淭hese are people who largely would prefer to be treated in the home or community,鈥� Miller says.
Studies show:
- palliative care at home or in a hospice costs up to a third less than hospital care
- patients who consulted with a palliative care team within two days of hospitalization had an up to 32 per cent reduction in subsequent hospital-health care costs, compared to patients not given palliative consultation
- palliative care may decrease unwanted aggressive end of life care as well as shorten length of stay in hospitals.
According to the Hospice Palliative Care Ontario Association, in 2014/2015 alone, residential hospices saved the Ontario health care system a minimum of $23 million because hospitals were able to admit patients to a hospice when it was evident they didn鈥檛 need acute care in a hospital.
The report says that as Canada and the provinces prepare to offer the sick and dying a doctor-assisted death, they should also guarantee expanded palliative care.
鈥淵ou can't do one without the other,鈥� Miller said. 鈥淚t would be unfair to Canadians and irresponsible."
Susan Ling is now a convert to the idea. She says she didn鈥檛 know much about hospice or palliative care, until her mother, Ester, was dying of pancreatic cancer. No longer able to care for her at home, she brought her to the hospice.
In her last month there, hospice volunteers helped bring in Susan鈥檚 father, who is also ill, to visit his wife, and helped the family celebrate Ester鈥檚 last days. She died Saturday.
鈥淚 am grateful from the bottom of my heart,鈥� Ling said. 鈥淚t gave my family a great sense of comfort.鈥�
The Dorothy Ley is supported by 340 volunteers who cook, visit with the residents, handle reception and visitors. And about 60 per cent of its budget comes from the provincially-funded local health network. The rest of the budget comes from donations.
鈥淚t would be so great to have more sustainable funding,鈥� Onen says.
The federal government has promised some $3 billion over four years to expand out-of-hospital and home care, and advocates are hoping some of it will go to improving access to palliative care.
As well, advocates hope the issue is discussed at a meeting of health ministers in Vancouver later in January.
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