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

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

Although home is the preferred final location, 75% of deaths still take place in hospitals and long-term care facilities. 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 individuals facing their own imminent death, or that of a loved one, by shifting the emphasizes from dying to living. After all, everyone, including an individual with a terminal illness, is living until the moment of death. Under hospice care, by definition, the final stage of life achieves the highest quality of living possible. 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 to their loved ones. Through the hospice movement, the quality of care involves emotional, psychological, physical and spiritual support in the last phase of life. This nurturing support also involves 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, in explaining that hospices complete the circle of care. "We hope to provide individuals [with a] choice of where to die."

Since only an estimated 5% to 15% 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% since its creation in 1987—from 9 founding hospices to 93 hospice organizations. Eighty-seven are home-oriented volunteer efforts which train selected volunteers to deliver services in the home and 7 members are residential hospices, including Toronto's Casey House and Hill House Hospices, and Ottawa's Carpenter House Hospice.

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 and the dismantling of universal health care, this may mean greater demand for palliative services and programs that enable Canadians to die at home or in home-like settings. In Ontario, more than 20 hospice organizations have started campaigns to develop residential hospices. 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 released its HAO Community Residential Hospices Standards. This is a pre-emptive strategy to anticipate design and management problems, and to establish widely-adopted standards that will 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 hospice services or volunteering opportunities could contact organizations equivalanet to HAO which provides an online directory and the End of Life Information Service (1-800-349-3111) as starting points. Local public health or healthcare agencies like Community Care Access agencies as well as the medical community will also direct inquiries.

For complete peace of mind, support your neighbourhood hospice movement before a crisis brings them into your life.