Your first step is to consider the population you hope to serve and how you will respond to its needs. Many hospice initiatives arise because of the focus of special interest groups. For example, a group may have a disease focus (such as HIV and ALS), a cultural focus or a geographical focus. Decide your focus and set up a working group.

Be sure to align your group with your local health authority and government because these entities will likely have a stake in ongoing operational issues. Your provincial or territorial hospice palliative care association and the Canadian Hospice Palliative Care Association can be helpful partners and sources of support.

Next consider the type of care you will offer. Will you provide care throughout the palliative phase, including actively dying (which requires a significant amount of skill and resources)? Or will you focus on respite care (which would have less intense resource implications)? Will you admit patients on a 24/7 basis (including emergent admissions), or have scheduled admissions during regular working hours?

Once you have decided whom you will serve and the type of care you will offer, assess the need for your services. How many people might benefit from such a facility in a year, and where are they now? If people are mostly in acute care facilities, you may be eligible for government funding because you will be freeing up acute care beds.

Knowing the kind of care you will provide and the volume of people you will serve will help you determine both the type and size of your facility and its operational costs. Operational costs are often a major issue for hospice development. Capital costs, such as buildings, are more attainable through donations and fundraising campaigns. Operational costs, however, are an ongoing issue that donors tend to be less enthusiastic about.

You will also need to explore staffing structure. Usually, you can contact other Canadian hospices to see how they are staffed. Staffing also involves consideration of unions and liability issues. If you intend to provide around-the-clock medical care, you will need to address the critical issue of medical care because many physicians no longer take after-hours calls.

We encourage you to link with other groups who have successfully developed residential hospice facilities in their communities. Fraser Health’s Hospice Palliative Care Program and many community groups throughout Ontario have expertise in this area. In Programs and Services, you can search by province to find palliative care programs and residential hospices closest to you.

You will find standards and guidelines for developing a hospice facility in Fraser Health Hospice Residences: Creating a healing & caring environment at the end of life. You will also find practical information in How to Develop a Community Residential Hospice Handbook & Toolkit, developed by the Hospice Palliative Care Ontario.