Jackie Wood has a plan. Behind a chain-link fence, in an industrial part of town, sits a vacant three-quarter-acre gravel plot of land that will one day, with any kind of luck, house a place where Toronto residents can live out their final days. There will be 10 palliative-care beds, a garden, a large kitchen for families to gather, a quiet room and even a prayer room.
But, as it stands now, that fence might as well be an impenetrable wall blocking Ms. Wood from carrying out her vision.
It took eight long years of unanswered door knocks and gentle letdowns before the Toronto Commandery Hospice was finally gifted provincial funding for nursing staff and a plot of land on Kincort Street, near Eglinton Avenue West and Caledonia Road in the city's northwest corner. Now that they've got those crucial parts in place, Ms. Wood's organization faces its most difficult hurdle: navigating through city bylaws. And for the organizers of a much-needed residential hospice, that hasn't been easy. There's no zoning for hospices in Toronto's bylaws, and the ones that do exist are generally near hospitals or in an existing building.
"We've tried to follow the rules. We've got the land. And now we run into this," said Ms. Wood, the hospice's director.
When Toronto Commandery Hospice members met with city planners to discuss the matter earlier this year, Ms. Wood remembers leaving the room dumbfounded, her head hung low. City planners, she said, threw up reams of bureaucratic red-tape and tried to essentially shut the door on plans for a hospice. They were told the hospice would never receive the go-ahead in an industrially zoned area. This, despite the fact that there is a long-term-care home just a stone's throw away and no one in the area had voiced opposition to the facility. Ms. Wood recalled being told to try and carve out space on existing hospital grounds, even though hospitals and hospices are two very separate entities. (Unlike a hospital, a residential hospice can keep residents for months, and provide bereavement support to the family after the resident dies). They'd already tried that route, knowing it could be easier to get approval, but hospitals in the city are reluctant to give up their precious space.
After less than hour of discussions, the conversation had reached a dead end. Now Ms. Wood's last hope is the city's committee of adjustments, which she and her colleagues plan to attend within the next month. They don't want to discuss what would happen if their bid fails, preferring to remain optimistic. At least, they can count on the support of businesses in the area, a hodge-podge of design studios and industrial companies, and the vote of their local councillor, Frank Di Giorgio. "It's a need. How can you stand in the way of promoting palliative care? We're not talking about a huge intrusion in an industrial community," Mr. Di Giorgio argued.
And the Toronto Commandery Hospice may be buoyed by the fact that the city is in the midst of rewriting its bylaws and it will include hospices. Joe D'Abramo, the city's director of zoning and environmental planning, said, for now, hospices have to work within the existing rules, although there may be ways to get around that at the committee of adjustments to get special approval. "I'm aware of the hospice movement out there, and that's why we're incorporating it into the new bylaw," he added.
But that could take months – and end-of-life care is needed now.
As the population ages, and the health-care system begins to feel the pinch, the need for hospices only grows. Toronto currently has only 28 beds in three hospices.
Palliative care in hospices is a more compassionate, home-like experience for patients and families, and less of a burden on the health-care system. The cost is only about $439 per patient a day, compared to as much as $1,000 for someone in a hospital bed. Unlike a hospital, only some hospices in the province receive government funding for nursing staff; they mostly rely on charitable donations.
Rick Firth, executive director of Hospice Palliative Care Ontario, said almost every hospice experienced its own set of challenges at the onset. Across the province, municipalities tackle the issue in their own way; there's no commonality on how hospices are zoned. There are 11 other organizations currently in the process of planning hospices across Ontario, he said.
"I really can't comment on why Toronto is going through the process that they're going through. I don't know their rationale. Certainly this facility is very needed. It's a very worthy organization," he said.
"If they [the City of Toronto]go through with this, it will be an indication that Toronto values these facilities and recognizes their importance," Mr. Firth added. "Providing quality hospice palliative care outside of a hospital setting is very important because there are many people that cannot stay at home to die."
Toronto Commandery Hospice's uphill fight felt like déjà vu when Beth Ellis was told about it. The situation was almost identical for her in Hamilton almost a decade ago. Her hospice was also gifted land, but there was no zoning for hospices in city bylaws. "It was not a smooth ride," Ms. Ellis, executive director of the Dr. Bob Kemp Centre, said of the year-long battle. "But we were optimistic." The 10-bed facility opened about five years ago and has since been thriving in the community.
Ms. Wood is not about to throw in the towel just yet. It took years to secure the land. Her organization pleaded with hospitals for a piece of their property, but was repeatedly turned down. She spoke to family of her frustration around Christmas-time, when her daughter's father-in-law, John Conforzi, piped in. He had a small plot of land, and was willing to donate it, as long as they named the hospice after his mother.
"If we weren't tenacious, we would have given up years ago," Ms. Wood said, while sipping coffee at a restaurant just down the street. "But we are tenacious and it has to happen in Toronto."
Philip Russel, president of the Toronto Commandery Hospice, shakes his head: "We've been at this for eight years, and it's a pity you have to slug so hard. After the meeting, Mr. Conforzi commented that he never dreamed it was so hard to give away something."
He paused. "It's a long process, and, well, we're trying to get things going."