Northern B.C. is looking for a nice place to die, and someone to pay for it.
The population here, like it is all over the continent, has an age bubble rising through the elder ranks. The biggest block of mature and senior citizens in our history is coming statistically closer to earthly departures.
Also reaching new heights is the social discourse on what Western civilization ought to do about death. Those topics cover territory as diverse as estate planning to long-term care facilities, from pension structures and do-not-resuscitate orders to euthanasia.
Palliative care is one of the cornerstone discussions as society is forced to embrace the well-financed, well-educated and traditionally outspoken baby-boom generation face its collective mortality.
"When people come into our facility and see what we do - these smiling, comforting people who want to provide their every wish - they are converted to believing in what we do," but many in society do not put any thought into it until they have a loved one admitted to their care, said Donalda Carson, executive director of the Prince George Hospice Society, the oldest freestanding palliative care facility in the province.
"It is because we are all products of a death-denying society," she said. "It is in our DNA, but we also are conditioned to avoid certain parts of the topic."
There is no denying it once you are at the bedside of someone in their final stages of life. People are admitted to hospice when they are in a terminal condition. Prince George hospice has onsite nurses, care aids, a doctor on call, and an army of volunteers attending to every wish of the guest. Visiting hours are 'round the clock. Pets are welcome. Children are encouraged. There is a lot of crying, but it might be surprising to know there is a lot of laughter and celebration as well.
Two weddings have been held inside Prince George's hospice walls. One guest exchanged vows with a longtime love as a final act of devotion. One guest could not attend a daughter's nuptials so the daughter and her groom brought the ceremony to the terminally ill parent.
But things don't always go serenely in the last moments of each expiring life there. One Prince George elderly couple spent the final days of their dying son at the hospice house, and came away with positive feelings about the facility. But when it was time for his wife to pass away from the effects of cancer, the husband was appalled at the pain she endured in her final days.
He reported that nurses were not allowed to give pain medication in the necessary doses, and the doctor who could was not available enough.
Carson said the staff has the medical certifications necessary to work in a palliative care setting, but extreme situations do occur, and she wished she could afford the additional resources to cover all possibilities. She admitted it was sometimes beyond the organization's grasp.
"I came here as a nurse, not as a fundraiser or a political analyst. That advocacy takes me away from work I really think I should be doing more of," she said. "Some people vehemently believe we should be fully-funded by the Ministry of Health. Why are we not? I can't answer it."
There seems to be little pattern to what the provincial government does invest in, for hospice needs. The freestanding palliative care facility in Kamloops receives $1.3 million per year from the provincial government, with overall revenues of almost $2 million (2008 tax figures).
The same year, Prince George's hospice received $750,000 from the provincial government, into a total revenue package amounting to $1.5 million. Victoria's hospice program is attached to a hospital, so it is funded by another unique formula.
"I'm worn out trying to figure it out," Carson said.
"Health authorities have implemented a range of services to meet the needs of clients at the end of life, including specialized palliative response teams, improved collaboration between physicians and home health services, and innovative uses of technology to provide 24/7 access to information," said Ryan Jabs, a spokesperson of the Ministry of Health Services. "Health authorities fund every publicly-subsidized, residential-care facility and hospice beds based on the service provided, size, location and age of each facility. Individuals who receive care in short term services, such as hospice care, pay a daily rate of approximately $30, which is the minimum daily client rate for residential care services. As with any other subsidized services, if people cannot pay because of serious financial hardship, the fee can be reduced or waived."
The Northern Health Authority's funding is responsive to the changing climate of palliative care, said spokeswoman Eryn Collins, but it was true that "every hospice in the province operates and is funded differently" because each has a different menu of services. Communication between the heath authority organization and the hospice organization was key to future success, she added.
"This planning was what directly lead to Northern Health support for P.G. Hospice's expansion from five to 10 beds - that doubling of capacity was intended to provide capacity to meet both current and future need," she said. "In terms of funding, prior to the five-bed expansion, Northern Health was funding P.G. Hospice at approximately $675,000 per year. That amount increased once the additional beds were open. For 2010-2011, Northern Health provided $855,000. This amount recognizes the fact that there is not a direct correlation between the number of a facility's beds and the cost of operating them, i.e. doubling the number of beds does not double the cost."
The actual cost of running the local hospice program, with its two spacious buildings and variety of programs, is not met by the NH contribution, meaning fundraising has to make up the shortfall.
"They are under-funded, unfortunately, and I think that is mainly because of a lack of understanding about what they do and what they stand for," said Lia Forrest. She works at RBC Royal Bank and stick-handled that company's two-year corporate commitment to Northern B.C.'s hospice facilities. Although the fundraising focus is now over, Forrest is still committed to the organization especially since her mother lived there in the final stages of life.
"The whole organization and what they do and what they stand for is very near and dear to my heart, so it wasn't hard for me," she said. "They aren't just clinical-type people. They truly are angels on earth. They make everyone their guest, and they hug freely. People don't go there to die, they go there to live.
In honour of this special connection between hospice guests and the people looking after them, one of the fundraisers (there were several) held by RBC employees was a hug-a-thon. Those going in and out of participating grocery stores in Northern B.C. could make a small donation and get a big hug. There were lineups, and people coming running, said Forrest, because people don't all have easy access to a good hug. It was hilarious, but also sometimes brought a lump to their throat as people talked about having no family of their own to share a good hug with.
Expand that to the final moments of life at the hospice facility, she said, and you have the power of those rare people who work or volunteer for Prince George Hospice Society.
Next week, in Part 2 of this examination of Prince George palliative care, The Citizen will take a closer look at who those people are and the challenges they face.
