“We've been coming out and saying, if you are providing a health-care service, then it should be part of the funding cycle,” said Sharon Baxter, executive director of the Canadian Hospice Palliative Care Association (CHPCA), by telephone from Ottawa.
Hospices are also expanding their range: While cancer patients are the most typical residents, Ms. Baxter imagines more and more of them will also care for patients with cardiovascular and neuromuscular disease; in fact, Winnipeg has a four-bed hospice to care for those dying of ALS (Lou Gehrig's Disease).
All of them offer home-like atmospheres, with sleeping chairs in each room for family members, a play area for children, and a kitchen that patients and their families can use at their own discretion.
“Dying in a residential hospice is lovely,” Ms. Baxter said. “That's what they do.”
Ontario Health Minister Deb Matthews described herself as a “huge believer” in hospices, saying it's “really important that we give people the best possible death. But she added, “I think we've got a ways to go before we get there.”
Though hospices are part of the province's plans, she noted the tough economic times: “I don't want to underplay how challenging our fiscal reality is right now.”
A chapel's mission renewed
The Kensington Hospice is housed in a chapel of dark wooden beams and yellow stained glass that was built in 1888 as part of St. John's Hospital for Women. Later, when the facility became Doctors Hospital, it was the auditorium.
Brian McFarlane remembers his first meeting in this room, addressing staff as Doctors Hospital's chief financial officer in 1969.
Three years later, he became chief executive officer. When the hospital was decommissioned in 1998, as part of a government restructuring, Mr. McFarlane led its reinvention: He turned it into a long-term and ambulatory care centre, under the umbrella of the non-profit Kensington Health.
The former chapel, however, sat empty for about a decade. Vagrants occasionally smashed the lock, taking up residence, as did neighbourhood rats. There were other ideas – youth programs, a mission – but finally in June, 2007, board approval paved the way to renovate it at a cost of $6.5-million as a hospice.
Kensington Health expected that government would one day recognize its value and fund the care of patients. So far it has not: Ontario's hospice subsidies per year are around $18.2-million, but for now the list is limited to the hospices operational in 2005, when funding began.
Down the hall from the chapel, Mr. McFarlane looked in on a back room overlooking the courtyard to say hello to a patient. Sitting up in bed was , a tall 55-year-old with a shock of white hair, who arrived on Aug. 23, as the hospice's very first resident.
At the time he had a life expectancy of two to three months, due to a colorectal cancer that had spread.
But while the route for many patients, such as Ms. Hoffman, follow an expected arc, dying also can be very unpredictable: Some patients who seem stable suddenly go into distress and die; others rally back after seeming on the brink.
As it turned out, Mr. McCarthy's carved granite headstone got to the cemetery before he did. The choir rehearsing hymns during Christmas was still singing them into Valentine's Day.
The hospice dog, a black-and-white Havanese named Douglas, became so attached to Mr. McCarthy's wife, , on their regular walks through the leafy residential area that it all but ignored its owner, hospice-care director Debbie Emmerson.
Meanwhile, Mr. McCarthy, whose career included posts as chief of staff in the Ontario government under Bill Davis and as an executive at the Canadian Jewellers Association and Pizza Pizza, made himself at home.
There was a bar cart with Irish whisky and a coffee machine. During Christmas, he had a wreath hanging on his room door for visitors, and another on the television so he could see it every day.
The family Calico cat, Marlowe, came on weekends, along with her litter box and food bowls. When the overhead lights were too bright, a worker installed a dimmer.
Even Bill O'Neill, the executive director of Kensington Health, got involved, hanging a framed picture.