Fifty years of compassionate care: Celebrating hospice palliative care in Canada

This year marks a significant milestone in Canadian healthcare history—the 50th anniversary of hospice palliative care. Since its humble beginnings in 1975, this specialized field has transformed how we approach end-of-life care, bringing dignity, comfort, and hope to countless individuals and families across the country. 

The origins of hospice palliative care 

The modern hospice movement began in the United Kingdom with Dame Cicely Saunders, who established St. Christopher’s Hospice in London in 1967. Her revolutionary approach emphasized pain management, emotional support, and treating the whole person rather than just the disease. This philosophy quickly spread across the Atlantic, taking root in Canadian soil in the mid-1970s. 

Dr. Balfour Mount, a urological surgeon at the Royal Victoria Hospital in Montreal, played a pivotal role in bringing hospice care to Canada. After visiting Dame Cicely Saunders in London, Mount returned to Montreal with a vision to transform end-of-life care. In 1975, he established Canada’s first palliative care unit at the Royal Victoria Hospital, coining the term “palliative care” to describe this approach in the French-speaking context. 

Mount’s work was groundbreaking not only for its clinical innovations but also for its integration within an acute care hospital setting. This model demonstrated that specialized end-of-life care could coexist with curative treatments, laying the foundation for the comprehensive approach we see today. 

Interestingly, few people realize that hospital-based palliative care is a Canadian innovation—one that began independently in two different hospitals. In November 1974, just a few weeks before the unit at the Royal opened, Saint Boniface Hospital in Winnipeg opened a “terminal care” unit, founded by David Skelton and Dr. Paul Henteleff. Both physicians worked independently in two different hospitals with no knowledge of what was happening at the other. 

The importance of hospice palliative care 

Improving quality of life 

Research consistently demonstrates that hospice palliative care significantly improves quality of life for both patients and families, and patients who receive palliative care experienced better pain control, reduced anxiety, and improved overall well-being compared to those receiving standard care alone. 

The holistic approach addresses not just physical symptoms but also psychological, social, and spiritual needs. This comprehensive care model recognizes that dying is a natural part of life and focuses on making the journey as comfortable and meaningful as possible. 

Economic benefits 

Hospice palliative care provides substantial economic benefits to the healthcare system. For example, studies show that: 

• Compared to usual acute care, hospital-based palliative care could save the health care system approximately $7,000 to $8,000 per patient 

• A 24 per cent reduction in hospitalization costs when patients with advanced cancer diagnoses were seen by a palliative care specialist within two days of admission  

• Patients receiving palliative care typically have lower healthcare costs, reduced emergency department visits, and shorter hospital stays.  

The Canadian Institute for Health Information reports that palliative care can reduce healthcare costs by up to 30% while improving patient outcomes. Home-based palliative care programs are particularly cost-effective, allowing patients to remain in familiar surroundings while reducing the burden on acute care facilities. This approach aligns with patient preferences—surveys consistently show that 70-80% of Canadians prefer to die at home. 

Supporting families and caregivers 

The impact of hospice palliative care extends far beyond the patient to encompass entire families and support networks. Bereavement support services help families navigate grief and loss, while respite care provides essential breaks for caregivers. 

Family members who receive palliative care support report lower rates of complicated grief and better adjustment following their loved one’s death. This support system creates a ripple effect of healing that benefits communities for years to come. 

Provincial Associations 

Over the past 50 years, provincial hospice palliative care associations have emerged as vital pillars supporting the growth and standardization of palliative care across Canada. They help coordinate services and advocate for improved care within their respective provinces. These associations have been instrumental in transforming the early vision of pioneers like Dr. Balfour Mount into a comprehensive network of community-based programs, ensuring that the principles of compassionate end-of-life care established in the 1970s could be adapted and implemented across diverse geographic and cultural contexts throughout the country. 

Key milestones over five decades 

1980s: Building foundations 

Following the establishment of the Royal Victoria Hospital unit, hospice palliative care began expanding across Canada. The 1980s saw the creation of the first free-standing hospices, including Casey House in Toronto (1988), which specifically served people with HIV/AIDS during the height of the epidemic. 

The 1990s and 2000s: Professional development and recognition 

The 1990s marked a period of professionalization, with the development of specialized training programs and certification processes.  

The Canadian Palliative Care Association (now the Canadian Hospice Palliative Care Association) was founded in 1991, providing a national voice for the movement and establishing standards for care delivery.  

The Royal College and the College of Family Physicians of Canada began jointly accrediting a one-year “Program of Added Competence” in Palliative Medicine, elevating the field’s status within the medical community. 

In 1999 Le Phare Quebec’s first pediatric hospice opened, welcoming children from across Quebec and working with CHU Sainte-Justine, the Montreal Children’s Hospital, and several regional hospitals to provide respite, end-of-life care, and comprehensive psychosocial support to families. 

In 2001 the Quality End of Life Coalition Care of Canada (QELCCC) (now the Palliative Care Coalition of Canada) was founded with over 30 national partner organizations.  

Also in 2001, the Government of Canada formally demonstrated its support toward advancing palliative and end-of-life care for Canadians by appointing Senator Sharon Carstairs, as Minister with Special Responsibility for Palliative Care (March 2001) and by establishing the Secretariat on Palliative and End-of-Life Care at Health Canada in June of that year. The Secretariat was directed to facilitate collaboration and coordination of effort with other federal government departments and agencies, representatives of national associations, professional associations, universities, researchers, the community, and, provincial and territorial governments. 

In 2002 CHPCA released The National Principles and Norms of Practice, a foundational Canadian document developed to provide a common framework for the delivery of high-quality, person and family-centred care for individuals with serious illnesses, aiming to manage symptoms and improve the quality of life for patients and their families.  

In March 2002, the Secretariat hosted the National Action Planning Workshop on End-of-Life Care in Winnipeg, Manitoba where over 150 national organizations, provincial, territorial and regional practitioners, researchers, educators, and government officials participated in the development of a five-year action plan for advancements in palliative and end-of-life care. 

A June 2002 meeting of the National Action Planning Workshop’s Steering Committee led to the first national strategy on palliative care and the establishment of five working groups organized to address issues in the areas of best practices and quality care, education for formal caregivers, public information and awareness, research, and surveillance. The national strategy was sunset in 2008. 

During this period, research into pain management and symptom control advanced significantly, leading to better protocols and improved quality of life for patients. The integration of interdisciplinary teams—including physicians, nurses, social workers, chaplains, and volunteers—became standard practice. 

The 2010s: Policy and accessibility advances 

The 2010s brought increased government recognition and funding.  

In 2012, the National Framework for Advance Care Planning was launched. The Framework provided a model for Advance Care Planning that could be used to guide all related activity, program development, and standards of practice in Canada. 

In 2012, the federal government announced one-time funding of $3 million over three years to support the development and implementation of a framework for an integrated palliative approach to care models in Canada. “The Way Forward: An Integrated Palliative Approach to Care” (The Way Forward initiative), led by the Quality End-of-life Care Coalition of Canada and managed by the Canadian Hospice Palliative Care Association, aims to improve access to hospice palliative care in a broader range of settings. 

In 2014, Canadian federal Health Minister Rona Ambrose announced a $3 million investment over three years to the Pallium Foundation of Canada to train frontline healthcare workers in palliative care, with the aim of improving access to specialized end-of-life care. This funding was intended to ease the strain on families by helping more Canadians receive hospice and palliative services. The initiative built upon a 2012 federal funding announcement of $3 million for community-integrated hospice palliative care models. 

In late 2017, the Act providing for the development of a framework on palliative care in Canada was passed by Parliament with all-party support. During the spring and summer of 2018, Health Canada consulted with provincial and territorial governments, other federal departments, and national stakeholders, as well as people living with life-limiting illness, caregivers and Canadians. The findings from that consultation, as well as the requirements outlined in the Act, provided the foundation for the 2018 Framework on Palliative Care in Canada. 

In 2019, the Action Plan on Palliative Care was launched. Budget 2021 provided $29.8 million over six years to advance the Action Plan and help build a better foundation for coordinated action on long-term and supportive care needs, including efforts to improve access to palliative care. Between 2019 and 2021, the federal government provided $24 million in funding for palliative care initiatives under the Action Plan. 

The 2020s: The Pandemic 

During this decade, provincial health systems began integrating palliative care more systematically, with some provinces developing comprehensive strategies to ensure equitable access across urban and rural communities. 

In 2021, the Canadian Interdisciplinary Palliative Care Competency Framework was launched; a culmination of years of collaboration among palliative care experts, governments, Canadians with lived experience and other interest holders.  

The COVID-19 pandemic accelerated the adoption of virtual care technologies in palliative care, enabling families to maintain connections when physical visits were restricted. This period also highlighted the importance of advance care planning and sparked conversations about death and dying that had long been avoided. 

In Closing 

As we celebrate 50 years of hospice palliative care in Canada, we honour the vision of pioneers like Dr. Balfour Mount and the countless healthcare professionals, volunteers, and advocates who have advanced this vital field. Their work has transformed end-of-life care from a medical afterthought into a sophisticated, compassionate discipline that affirms the dignity and worth of every individual. 

The journey from a single hospital unit in Montreal to a nationwide network of services  and organizations such as CHPCA, Palliative Care Coalition of Canada (PCCC),  Pallium Canada, Canadian Virtual Hospice, Canada’s Pediatric Palliative Care Alliance, Canadian Palliative Care Nursing Association, Canadian Society of Palliative Medicine, and the Canadian Cancer Society demonstrates the power of innovation, dedication, and human compassion. As we look toward the future, the principles that guided those early pioneers—respect for persons, attention to suffering, and commitment to quality of life—remain as relevant today as they were five decades ago. 

The next 50 years will undoubtedly bring new challenges and opportunities, but the foundation built over the past half-century provides a strong platform for continued growth and improvement. Through continued investment, innovation, and advocacy, hospice palliative care will continue to serve as a beacon of hope and comfort for Canadians facing life’s final chapter. 

As we mark 50 years of palliative care in Canada, we also honour the memory of Dr. Balfour Mount, whose vision and leadership laid the foundation for this movement. His legacy continues to inspire our collective efforts to ensure quality palliative care for all Canadians. 

We also recognize that this reflection cannot capture the full history of palliative care in Canada. Many voices, experiences, and milestones are missing, and we remain grateful to all those whose contributions have brought us to this point. 

 

 We extend our sincere thanks to Sharon Baxter for her invaluable contributions and thoughtful guidance in shaping this blog. Her insights and expertise were essential to its development.