The year she arrived in Canada she made fast friends with a nurse named Rosaleen Dunne, also from Ireland, who already specialized in palliative care at Scarborough Grace Hospital.

Rosaleen had come to Canada after completing her nurse training and after taking a tough induction to palliative care in northern Kenya where she worked in a small clinic “doing the best she could” during a dreadful famine.

But in the midst of this human carnage, Rosaleen says she learned some important lessons about the end of life.
“In that culture, death seemed more a part of life, and they were not shy at expressing their grief in public,” she said. “Here we don’t want to talk about it or entertain the idea.”

After 20 years in the palliative care ward at Scarborough Grace Hospital, Rosaleen moved on to Quinte Health Care as palliative care co-coordinator for QHC’s four hospitals, and ironically she is still the only trained palliative nurse there.

COMPLETING LIFE’S CYCLE

Looking back, Rosaleen never realized that just down the corridor in the maternity ward of Scarborough Grace, a nurse named Lynda Pecora was birthing babies. The two never met until Rosaleen bought a house in Warkworth eight years ago.

From early on in her career Lynda, a longtime Northumberland resident now living in Hastings, juggled parallel careers as both a birthing and palliative care nurse. “I like to think it was all about completing life’s cycle,” she said.

Today as The Bridge Hospice, a $350,000 custom-built facility, prepares to open its doors, the three women who gave birth to an idea 30 years in the making all agree on its true purpose.

“We find with many people that when they come into the hospice, it’s giving them permission to do what they need to do, to die. We give them peace,” summed up Lynda.

FORMIDABLE ROADBLOCKS

Certainly the six-year journey to complete the hospice was not travelled without overcoming some formidable roadblocks: government red tape, initial public apathy, and a fund-raising drive that almost stalled. But in the end, Warkworth’s legendary spirit rose to conquer all.

“We all agreed that Warkworth had such an energetic, forward thinking group of people and they were all the qualities we felt we needed for bringing in a hospice,” said Lynda.

When it comes to floating new ideas and raising money in this Victorian village of 600 souls, there is really only one place to go: the Warkworth Community Service Club. The three women asked for a meeting with the club’s five-man executive to officially roll out their hospice plan.

Lynda Pecora said their hearts “were pounding” as they walked into the meeting in May, 2005, held in the basement of the village’s medical centre. Nervous or not, they made a huge impression on the five men sitting across the table from them.

“They came through the door of the meeting room like a benevolent hurricane,” said Dean Peters, then chair of the Service Club. “I don’t ever recall seeing or hearing three individuals who had such a powerful message. From their first presentation they absolutely hooked me.”

That critical first meeting was much more than a pitch for funding. The three women were also sending up a trial balloon on their shared philosophy about palliative care in a residential hospice.

It made a huge impact on the Service Club Executive hearing their message for the very first time.
“Of course everybody carries around with them their own ideas and their own fears of death and dying,” said Dean Peters. “I had no idea there was another world associated with death and dying, another world of care and compassion…”

Indeed Peters, then a Trent Hills municipal councillor, was so impressed that he agreed to be the chairperson of the new hospice organization – and not without a few early misgivings.

A ROLLER COASTER

“It’s been a roller coaster, it surely has,” he admitted. “At the first board meeting I remember looking around the room and thinking ‘Oh my God’ how are we ever going to do this?”

With his business career experience, Peters knew that to succeed, the new hospice needed a good mix of people drawn from the business and medical worlds, people with vision and others who could roll up their sleeves and get the job done.

“And we had some of each of those but we didn’t have the bench strength we needed,” Dean realized as he viewed the thinly populated audience. “But that’s what we developed over the years.”

First the new foundation had to establish itself as a non-profit charity and come up with a name: The Bridge Hospice. “We thought of the name because The Bridge Hospice will be a bridge between healthcare and the community and a bridge between life and death,” said Lynda Pecora.

After an initial flurry of activity to put the organization on a firm footing, the promoters of the hospice faced a bigger task. Namely to persuade the community at large that there was a pressing need for this kind of palliative care.

Three successive doctors holding the chairpersons job after Dean Peters – psychiatrist Cheryl Gibson, missionary Bob Stephens and current chair Bob Henderson – helped to get the message across.

“People want to die at home; I want to die at home; we all want to die at home,” said Henderson, who is medical lead at the Trent Hills Family Health at The Bridge Hospice we see dying at home as the gold standard.”

But Dr. Henderson contends that all too often a person dying at home puts impossible stress and strain on the family struggling to provide round-the-clock care giving.

“When things get down to the last two or three weeks of the loved one’s life, the care demands escalate just at the time that the family’s energy and resources are depleted,” he said. “When those two lines cross, it becomes very, very difficult to maintain people at home.”

DYING IN HOSPITAL

“Often in desperation that dying person is taken to the hospital emergency department because there is really no other place. The patient is admitted and dies in hospital, “Henderson pointed out.
“An acute care institution like a hospital is not the best place to provide palliative care, no matter how good their intention. And you ask anybody who works at the hospital from the CEO down and they all agree with that,” he said.

In 2007-08, 25,000 people in Ontario were classified as palliative patients in our hospitals. They took up almost half-a-million hospital bed days, many of them in emergency rooms, as they waited to die.

Diverting those palliative patients to hospice beds where they still received a full level of medical care would obviously have a dramatic effect on wait times for other patients. It could also save hospitals up to $51 million a year. 

Certainly Canadians would support the idea. A recent survey found that almost 90 per cent of people “think it’s very important to be able to die in familiar, comfortable surroundings”. The same survey estimated only 30 per cent of Canadians with advanced illness would actually receive palliative care.

Senator Sharon Carstairs, who has agreed to be Patron of The Bridge Hospice, sounded the alarm only last year about the pedestrian approach of federal care when she tabled a report entitled Raising the Bar: A Roadmap for the Future of Palliative Care in Canada.

In that report Senator Carstairs warned: “The evolution of palliative care is being profoundly affected by the increase in chronic diseases. Combined with an aging population, the system is being stretched and tested as never before.”

But even so, the Ontario Ministry of Health and its regional LHINs (Local Health Initiative Networks) are slow to throw their weight behind small residential hospices – especially in rural areas.

The ministry’s preferred funding model, now seven years-old, is a 10-bed hospice and that proposal was actually put to the Warkworth team by the Central East LHIN.

“The reality is that a 10-bed hospice requires about $1.5 million a year just to function,” says Dr. Bob Henderson. “The ministry will likely provide each of those facilities with $550,000 which means it’s then up to the hospice to raise $1 million a year to a rural community like Warkworth.”

The Bridge Hospice expects to cater to between 25 and 30 palliative patients a year with an average stay of about two weeks each. After an initial startup period, provincial figures predict they can expect a 95 per cent occupancy rate.

And even when the Warkworth team laid out its proposal for a modest, workable plan tailored to the village’s needs, they hit bureaucratic inertia.

“We have had official and unofficial talks with people in the Central East LHIN and the basic message that came back was they have not made a decision; they have not taken a position on what they should do with residential hospices in their area,” said Dean Peters. “So we really had no choice but to carry on if we wanted it done.”

A HIGH-WIRE ACT

Moving ahead without government support was an act of extreme faith for the Warkworth team, not unlike walking the high-wire without a safety net.

At one point fund-raising had slowed down to a trickle and the Hospice project seemed to be stuck at $200,000 – well short of the $350,000 it needed.

“We got to a period where we were going nowhere and people were bumping heads together and it was because we did not have a clear vision. There was a lot of fear about moving forward,” said Lynda Pecora.

Dean Peters was so worried about the project coming to a complete halt that he even put in a private bid for an existing house in Warkworth, hoping it would kick-start donations again.

“We didn’t get the house but it got people thinking about what we needed to do,” Lynda said. Their next and best move was to contact the only other residential hospice in this entire region at Bancroft. “Bancroft is our model and we have used a lot of their ideas and a lot of their energy,” Peters said.

In fact, the North Hastings Hospice in Bancroft, also a three-bed facility, had been receiving $50,000 a year from the province to partially fund two of five programs it operates – the home visiting volunteer palliative program and a bereavement/grief support program. Last year they told South-East LHIN “no thanks” to the grant after discovering it would cost them $30,000 a year to pay for a full-time staffer to meet all of the ministry’s reporting standards.

The Bridge Hospice got its big break just last year when retired farmers Brenda and Ken Partridge offered to sell one acre of land on Old Hastings Road for a “very reasonable price”. At last, The Bridge Hospice had found a home.

News of the land purchase was like a shot of adrenalin for the fund-raising team. Money poured into the Hospice and in less than a year they reached the elusive target of $350,000.

A CARING COMMUNITY

Shovels went in the ground back in May and construction of the new hospice is to be completed by the end of September. The Hospice could accept its first palliative care patient by the end of October.

“I have been involved in several volunteer exercises over the years,” said Dr. Bob Henderson. “But this has been a fascinating, wonderful experience working with a very large number of talented volunteers.”

But having successfully scaled the mountain of getting their hospice built, Warkworth will have to mount a continuous fund-raising drive to pay for the hospice’s operating costs – likely to be in the region of $150,000 a year.
Bancroft has plugged the funding gap with outstanding community support and the team
in Warkworth believes they can do it too.

“We have had nine or ten different revenue streams that we have been fortunate enough to benefit from over the years,” said Peters. These included events organized by other people who donate to the hospice – such as Bev Roy’s annual events, the Black and White Ball and her fashion show, and the W8 Run organized by local pharmacist Bryce Miller.
Another money-maker is the Hospice’s own golf tournament run by Stella Stacey.

Increasingly the hospice is receiving more bequests in lieu of flowers from local funerals as well as cash gifts from couples’ celebrating their second marriage.

There have been a number of major donors, notably local resident Aureen Richardson, who gave $50,000 to the hospice, and corporate donors like Cameco of Port Hope.

Another steady source of income is The Bridge Builders List made up of donors who pledge $1000 a year for three years. And each newsletter mailed out by the hospice includes a minimum $5 pledge form. Today, The Bridge Hospice has a donor database of 800 people. 

“I think it’s amazing when I look back on it. The people who have been involved have been incredible,” said Rosaleen Dunne. “They’ve stuck with it. Somehow it has touched people because they have believed in the possibility.”

And Pauline Faull thinks the success in Warkworth is about much more than raising money. She believes it signals that the community has warmly embraced the idea of talking about death and how they can help people to die with the warmth of compassion and caring.

“Normally people don’t like the word death, don’t like the very fact that we are going to die. And yet that is something we have to face at some point,” Pauline remarked.
“I think that the people in Warkworth are highly aware of this happening and they have put their backs to it. That part of them will open up, it’s in all of us, and it will be very good for them.”

Flashing a broad smile, she said The Bridge Hospice “takes death out from behind the kitchen door”.

“It’s got so we didn’t even call it death anymore, we called it passing,” she said, warming to her message. “You cannot put rouge on it and say you’re alright. Let’s call it death, there’s no getting away from it.”

“This hospice has joined the community together and that’s what I like about Warkworth. This is a community I really, really respect.”

THE BRIDGE HOSPICE FAST FACTS

Location: Old Hastings Road, Warkworth
New building: 2100 square feet 
Accommodation: three palliative care bedrooms
Facilities: Common room, dining room/kitchen, quiet room, office and store room
Hours: 7 days a week, 24 hours a day
Staff: Registered Nurse and/or Registered Practical Nurse on-site at all times when patients are in-house.
Support staff: large team of volunteers
Fees: zero
Conditions: patient must be in the last two-to-three weeks of life (palliative patient scale).
Further information: www.thebridgehospice.com