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Basia Hoffman (facing the camera) hugs social worker Maxxine Rattner during a visit with her 90-year-old mother, Andrée Hoffman, who spent her final days at Kensington Hospice, a 10-bed palliative care facility that opened last summer in Toronto. (Peter Power/Peter Power/The Globe and Mail)
Basia Hoffman (facing the camera) hugs social worker Maxxine Rattner during a visit with her 90-year-old mother, Andrée Hoffman, who spent her final days at Kensington Hospice, a 10-bed palliative care facility that opened last summer in Toronto. (Peter Power/Peter Power/The Globe and Mail)

End of life

To go gently into that good night: When quality of death can enhance quality of life Add to ...

Andrée Hoffman lay on a gurney, the outline of her body visible under a floral comforter. Her daughter Basia Hoffman, in her 50s, was a few feet away, playing Beethoven's Moonlight Sonata on the piano, hours after her 90-year-old mother's death. No one was in a hurry to go to the funeral home.

When the time finally came, those who loved gathered around her body for a procession through the halls of Toronto's Kensington Hospice to the front door. In her final days, the staff had given her oxygen to ease her breathlessness, narcotics to help with pain and baths to keep her clean. They even cooked breakfast for her family – the scent of pancakes and eggs lingered in the air, a smell of home.

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“You almost feel guilty,” said Basia's sister, Tatiana Hoffman, 56, “because they make it so beautiful and wonderful. But I feel so much relief she is out of pain.”

Nine days earlier, Tatiana and her 18-year-old daughter Carina had found the elderly lady slumped at the breakfast table in her Toronto home. Her right eye and bottom lip were drooping. She was taken to hospital, where they found she had suffered a devastating stroke. A few days later, she was brought to this 10-bed residential hospice.

Make no mistake, she came here to die, as 46 others have since it opened in late August. Each one of them had a procession like hers, making death not an institutional problem to be dispensed with, but an event to mark.

Over four weeks this winter, a Globe and Mail reporter and spent time at Kensington Hospice, to observe the model that many experts consider the future of end-of-life care – a more compassionate, all-encompassing experience for patients and families, and more affordable and sustainable for the burdened health-care system.

Palliative care in a hospital provides symptom relief and comfort, as a hospice does, but hospital stays are generally limited to around 15 days. A residential hospice is a standalone institution that can keep residents for longer – usually around three months – and provide bereavement support to the family up to a year after the resident dies.

In every province, health-care costs are consuming an ever-greater proportion of spending – it's not inconceivable that the numbers could reach 50 per cent in the future. And late life is particularly costly: One study found that 25 per cent of all health-care costs are devoted to patients in their last year of life.

How to deal humanely with that problem is a crisis facing the whole country. Part of the solution may be for more of us to rule out ahead of time the use of “heroic measures,” those extreme technological steps to prolong life no matter how marginally and expensively.

Another element, represented by the hospice movement, is to improve what one might call the quality of death.

While most people would prefer to die at home, most can't: About 70 per cent of patients die in hospital, places more focused on saving lives than on ushering in their endings. The number of palliative-care patients cared for in acute-care hospitals is increasing, from 84,815 two years ago to 91,901 in 2010-2011.

A Royal Society of Canada report has found that while 95 per cent of terminal patients would benefit from palliative treatment, as many as 70 per cent of Canadians still lack access to such programs. With the aging population, those numbers are only expected to intensify.

Hospices provide a more home-like experience, while costing only about $439 per patient a day, compared to $850 to $1,000 in a hospital bed.

There are at least 63 residential hospices across Canada, ranging from a few beds in a home stitched together with volunteers and visiting doctors to 10-bed institutions. Because the model is not fully established and integrated into the health system, only some hospices receive provincial funding. Those, such as Kensington, that run mostly on charity are arguing that it is time for that to change.

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