404 Changing the Face of Rural Hospice – Bringing Death Back Home | Stephen Garrett

Changing the Face of Rural Hospice – Bringing Death Back Home

The 21st century is bringing new and different challenges to the work of hospice as evidenced by many changes in our healthcare system and in our communities. Some of these changes are:

Doctor Assisted Dying

Necessity for End of Life Planning and Paperwork

Increasing Rate of Death

Changing Demographics & Urban to Rural Migration

Health Care Budget Challenges and Nursing Shortages

Green Burial and Home Funerals Movements

The current annual death rate in British Columbia is 34, 633 (2014) and we are heading for 45,023 by 2030 and 54,928 by 2040. From a geographic vantage point, a rural city like Osoyoos will see 82% of its population over the age of 65 by 2030! (A recent study by the BC Business Council) If you drive from Vancouver to Salmon Arm you can actually see the migration of seniors from expensive Vancouver to rural BC – I did that drive last fall and was shocked to see how many seniors residences are being constructed!

BC’s annual healthcare budget is flirting with $17billion, 41% of the annual provincial budget, and research shows that we spend nearly half of our annual healthcare budget on 5% of the population in the last 10 months of their lives – that’s $8.5 billion dollars, much of it resulting from a lack of preparation, fore-thought, and our collective unwillingness to accept death. We are currently short 1,600 nurses and many doctors here in British Columbia and that is particularly evident in rural BC.

More and more, individuals and families are facing a complex and over-taxed healthcare system that is demanding extensive preparation from its patients. Given our death adverse tendencies here in North America it leaves close to 83% of our population horribly under prepared for their ultimate end of life. Not only are most Canadians unprepared for their ultimate death, many refuse to even talk with their families about it. As a result confusion, often chaos, emotional upset, and infighting tend to be commonplace as end of life approaches. Poor decisions are made under emotional duress and often cost the families and the system financially as well as emotionally, spiritually, and physically.

90% of British Columbians are choosing cremation and the Green Burial movement is building some ground support as the baby boomers intentionally want to leave much smaller footprints on the planet and reduce the cost of their funerals.

The environment hospice finds itself in currently is demanding new services and approaches as the needs of the people we serve have changed significantly from the inception of hospice some 50 years ago.

What would happen if rural hospices around British Columbia took on the challenge of preparing individuals, families, businesses, and local governments for the end of life? What would happen if hospices took on the role of end of life educators? What would happen if hospices got involved in end of life conversations well before dying and death were occurring?  How would this change of focus affect your hospice, board, staff, and volunteers?

Now this is not to say that this additional focus would replace all the amazing and important services hospice already offers to its community. It would mean though, additional resources be applied to the ‘proactive’ piece of early education and preparation of end of life paperwork for your community members –end of life outreach if you will.

What would happen if hospice became an even larger part of the solution?

Instead of our culture’s tradition of out sourcing the care of our dying and the care of our dead how could hospice participate in preparing families for home deaths and home funerals? Could hospice create additional revenue from workshops designed to help individuals prepare well for dying and death with dignity and grace? What would happen if hospice teamed up with the local municipal government and a nursery and co-created a green burial site from which they could earn revenue?

My colleague Don Morris and I would be happy and honored to work with your hospice, in your home community to answer these many questions and to create with you a working action plan to Change the Face of Your Hospice and help you prepare staff and volunteers to be community educators and trainers. This could look like a one-day workshop for your board and staff followed by a one-day public workshop to get the ball rolling.

We would also be happy to facilitate a Death Café in your community to begin the public conversation that needs to happen if we are to negotiate our way through these interesting times of dying, death, and disposition. We are also happy to meet with local newspapers, politician and business leaders to help spread the word – We can die better!

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