Hospice Without Borders

A Plan to build and operate a residential hospice centre for Kootenay Boundary!

 

Unfinished business: Palliative care

Canada’s health care regime is lauded abroad. There are problems, to be sure — wait times, especially for elective surgery; shortage of medical specialists in less-populated areas, Health Canada’s glacial pace in new drug approvals, to name a few. Nonetheless, the universality of our health care system makes it the envy of the world, including the United States where forty-five million citizens are without medical coverage.

And yet, there remains one glaring gap in health care where Canadian governments have been slow off the mark, certainly slower than the need demands. Palliative care deserves much more attention and action from government than it currently receives.

Fortunately, local communities in Kootenay Boundary region are stepping up to the plate. And, the results are impressive: When illness is no longer responsive to treatment aimed at cure, volunteer hospice groups offer holistic palliative care, providing physical, emotional, psychological, spiritual and practical support to people facing a life-threatening illness and to their families and friends.

But, more needs to be done, as the Castlegar Hospice Society has recognized.Its plans for a ten-room residential hospice are laudable and timely, and deserve the enthusiastic support of the community at large and of the Province of British Columbia’s decision makers. 

Hon. Roger Simmons, PC, former chair, House of commons Standing Committee
on Health, & author of the hospice project business plan.

The Palliative need in Kootenay Boundary

  • An estimated 500 people die annually in Kootenay Boundary from a palliative illness such as cancer, end stage heart, lung and kidney disease, AIDS, etc.
  • The area has a large senior population that is virtually overwhelming the region’s hospital system and severely limiting timely access to acute care hospital beds.
  • Most (up to 75%) palliative people need to be hospitalized during the last month of life because they require 24-hour care that families are unable to provide.
  • More than 300 palliative people die in acute-care beds every year in the region’s hospitals. These are people whose symptoms are stabilized and could be at home or in a hospice.
  • With a large and burgeoning senior population, the number of palliative deaths in Kootenay Boundary is expected to double in the next 20-30 years.

Responding to the Challenge

  • Clearly, the solution is a residential hospice to serve the Kootenay Boundary region, a palliative-care home that provides 24-hour medical care to people who can no longer stay at home through the end of life and do not require the expensive and highly medical, technical care available in a hospital.
  • A well-run residential hospice proves compassionate and cost-effective care for patients and loved ones when the curative medical approach is no longer achievable.
  • A 10-bed residential hospice, serving 125 to 150 patients/year, will adequately address the current need in the region.

A Compassionate, Cost-effective Solution

The establishment of a residential hospice in Kootenay Boundary will achieve several positive results:

  • An estimate 125-150 patients per year who would otherwise face hospitalization in the last month of life, will, instead, receive quality care in a residential hospice program;
  • Hundreds of families and loved ones will be supported by the care offered in this program;
  • People requiring elective surgery who are currently on long wait lists due to limited access to acute care hospital beds will receive their surgery in a more timely fashion.
  • Research has found that residential hospice represent “a significant advancement to the care offered by” health authorities.

The Non-Palliative Case for a Hospice

  • A residential hospice in the Kootenay Boundary region will free up hospital acute care beds, reducing wait times for elective surgery patients and saving scarce health care dollars.
  • In addition to its palliative care obligations, a residential hospice can also cater to the special needs of non-palliative clients, specifically, those who require pain-symptom management and those whose loved ones require respite care.
  • A residential hospice will improve the region’s quality of life, especially for loved ones of palliative care patients.
  • A residential hospice will provide an additional site for clinical placement options and relevant, meaningful learning experiences for students enrolled in the nursing degree, health-care assistant and human services programs at Selkirk College.

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1 “There is good evidence that surviving family members who participate in a hospice program prior to a loved one’s death, experience less feelings of guilt, dependency, loss of control, despair, numbness, shock and disbelief, compared to those who do not participate in these programs.” (Dr. H. Chochinov, Canada Research Chair in Palliative Care & Director, Manitoba Palliative Research Unit).

2 “…ten beds is the smallest size possible to provide efficient and effective staffing for a dedicated hospice residence.” (Fraser Health Hospice Residences, 2007)

3 “The cost of delivering hospice palliative care in a residential hospice baed is $300/day in comparison to $1000/day in an acute care hospital” – “Realize The Dream”, Hospice Greater Saint John, NB, 2009

Projected Capital Costs

Land:
In-kind contribution from the City of Castlegar ($241,800)
Site Development, Construction:

The following cost projections for a ten-bed hospice are based on estimates supplied by Fairbanks Architects of Nelson.

  • Site development $ 300,000
  • City development costs $ 100,000
  • Materials testing $ 10,000
  • Consultant fees $ 260,000
  • Building $ 2,300,000
  • Contingencies (5%) $ 156,000

Total: $3,126,000

Equipment, furnishings:
The estimate which follows is based on information obtained from the
Salvation Army Rotary Hospice House in Richmond:

Equipment & Furnishings $ 400,000

Total projected capital costs $3,526,000
total projected capital cost, including land $3,767,800

Annual Operating Costs

It is estimated that the annual operating requirement of the proposed hospice will be one and a half million dollars, an estimate based on the operating budget of a ten-bed hospice in the BC Lower Mainland, including funding, amounting to nearly a million dollars, from the Province of British Columbia. On the assumption that the Kootenay Boundary hospice can expect comparable provincial funding, a revenue shortfall of half a million dollars would need to be raised annually to balance the operating budget.

The projected annual fundraising requirement does not appear to be unduly onerous if the experience of other residential hospice operations throughout Canada is used as a reference point. Hospice Greater Saint John noted the following in its March 2009 “Realize the Dream” document.

“All other Canadian hospices have reported success in securing significant
additional community support through bequests, memorial donations and event
support to cover the cost of residential hospices and ensure sustainability .

“Most report their general donations rose as much as 300% in the first year
of operations.”

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A Supportive Community

The project has widespread support in the region. An outline and print poll last May showed overwhelming recognition of the need for a residential hospice.

The Mayor and Councillors of the City of Castlegar gave a much appreciated shot in the arm to the project by donating land with a market value of a quarter of a million dollars.

And, the Society is buoyed by the unequivocal support of other stakeholders, including the Mayors of Nelson and Trail, fellow hospice groups in Kootenay Boundary and others.
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