Hospice care shut out of Ontario budget

After Ontario Finance Minister Peter Bethlenfalvy finished outlining how his government intended to spend $204 billion in 2023-2024, hospice director Julie Aubé and her team at Maison McColloch Hospice in Sudbury were still dependent on the Sudbury Food Bank to feed patients at the largest hospice in the province.

To be clear, the Sudbury hospice isn’t actually picking up cans of soup at the local food bank and feeding them to residents in their final days. The food bank serves as a central fundraiser for a range of charities in the Northern Ontario city, Maison McColloch being one of them. Aubé’s staff shop for groceries at a grocery store, where they have an account thanks to the food bank.

The food bank does supply fresh fruits and vegetables, along with fresh milk, directly to the hospice.

“But that’s it. It’s not canned goods. We buy our own groceries,” said Aubé.

That’s not how hospitals feed their patients. Nor do they run 50/50 draws to pay their cleaning staff or golf tournaments to buy new bed linens. Except for hospices, Ontario’s health-care system doesn’t doesn’t have a craft sale to pay the electricity bills.

“We’re a specialized health-care facility that’s relying on charitable donations to operate,” Aubé explains. “We don’t get a funding envelope for food. We don’t get funded for housekeepers or maintenance people or cleaning supplies — none of that. The only things we get money for are PSWs, RPNs and RNs.”

Hospices did get a small mention in the provincial budget. Bethlenfalvy re-announced 23 new hospice beds, adding to the 500 currently serving Ontarians.

Despite these 500 beds, there are nearly 6,000 patients in Ontario hospitals designated “alternate level of care” or ALC. These are patients who don’t need the services of a hospital but can’t safely be sent elsewhere, and they represent about 17 per cent of hospital patients. Forty per cent of those ALC patients are likely in the last three months of their lives. 

Given the infrastructure of a hospital, hospice care costs about one-third of a hospital stay.

Maison McColloch Hospice is Ontario’s largest single-site hospice with 20 beds in individual rooms. It’s part of the St. Joseph’s Health Care Village of Care. 

“We need to focus on what we do best, which is health care — end-of-life care,” said Aubé. 

Event planning, fundraising letters, media savvy appeals and partnerships aren’t included in training for palliative nursing.

“We’re providing bed capacity to our hospitals that are already bursting at the seams,” said Aubé. “People should not be going to die at acute care hospitals. That’s not what they’re for. Hospices create that end-of-life care experience.”

Maison McColloch Hospice doesn’t just provide palliative care for patients. It provides grief counselling and other supportive care services to families. The hospice has trained volunteers to go into homes and provide respite services to care givers, along with companionship to people who are dying at home.

The hospice is a hub for public education that supports caregivers, and in that work is aligned with the Northern Ontario School of Medicine.

“We’ve been reaching out to long-term care homes who are looking to make their palliative care services a bit more robust and looking for ideas,” said Aubé. “We would like to be seen as the hub for the community — boots on the ground to be able to access resources for all things palliative care.”

All together, Maison McColloch services keep people out of the emergency departments, and “that’s invaluable,” said Aubé.

The choice to fund hospices as if they were a second tier of health care isn’t morally neutral, said Canadian Catholic Bioethics Institute executive director Moira McQueen.

“It’s a moral choice,” she said. “There is a limited amount of money in the pot. How you divide that up is a moral choice. There are practical elements, but there are moral elements.”

Before the budget came down, the Catholic Health Association of Ontario was really hoping for more permanent and stable funding for hospices.

“We continue to advocate, in alignment with Hospice Palliative Care Ontario and the Ontario Palliative Care Network for increased funding for hospice care as the current funding model only covers approximately 50 per cent (direct nursing care only) of the costs of running a community-based in-patient hospice,” said CHAO president and CEO Ron Noble in an email. 

The Catholic Register reached out to the Ministry of Health by email and phone for comment but received no reply.