Palliative Care Everywhere: A Call to Action for Access, Equity, and Continuity in Canada

A joint article by CHPCA and CHCA | Download a PDF of this Article

Each year, Canadians pause during National Hospice Palliative Care Week to reflect on how we care for people living with serious illness, and how we support their families. This year’s theme, “Palliative Care Everywhere,” is both a vision and a challenge. It asks us to imagine a country where high-quality palliative care is not limited by location, age, race or ethnicity, diagnosis, housing instability or setting, but is available wherever people are, whenever they need it. 

Palliative care, as it is understood today, has evolved significantly over the past several decades. While it first emerged in Canada in the 1970s as a hospital-based specialty focusing largely on cancer care, it has since grown into a broader approach that supports people living with many types of life-limiting illness (Government of Canada). As Canada’s population ages and more people live longer with complex health needs, the role of palliative care continues to expand.  

At its core, palliative care is about reducing suffering and improving quality of life. It includes managing pain and other symptoms, while also addressing emotional, social, and spiritual needs. It recognizes that serious illness affects more than just the body, and that care must respond to the full experience of the individual and those around them. It also extends support to families and caregivers, both during illness and through bereavement. 

A palliative approach to care places the person and their family at the centre of all decisions (Government of Canada). It emphasizes understanding what matters most to the individual, and ensuring that care aligns with their values, preferences, and goals. This approach can and should be introduced early in the course of illness and can be provided alongside treatments intended to cure or prolong life. Palliative care is delivered by a range of providers across settings, including home and community care, long-term care, hospice, and hospital. 

In Canada, this approach was shaped in part by the work of Balfour Mount, who helped establish the country’s first palliative care unit in Montreal in the early 1970s and introduced the term “palliative care” into the Canadian healthcare system. His work helped shift the focus of care toward comfort, dignity, and quality of life, principles that continue to guide the field today. 

Yet despite its proven benefits, access to palliative care in Canada remains inconsistent. Recent national data indicates that just over half (58%) of Canadians who died in 2021-2022 received some form of palliative care, and for many, that care was introduced very late in the course of illness (CIHI, 2023).  

Early and integrated palliative care not only improves quality of life, but also reduces avoidable hospital admissions, lengths of stay, and pressure on acute care systems (CIHI, 2023). However, in Canada, half of patients die within just 22 days of being identified as palliative, highlighting how often care is introduced too late to fully benefit patients and families (CIHI, 2023). These gaps highlight a fundamental issue: while the philosophy of palliative care is widely accepted, the reality of delivering it “everywhere” is still out of reach for many. 

What Does “Palliative Care Everywhere” Mean? 

The theme “Palliative Care Everywhere” emphasizes that care should follow the person, not the system. Whether someone is in a hospital, hospice, long-term care home, or their own home, they should have access to consistent, high-quality palliative care that starts with diagnosis.  

It also means recognizing that palliative care is not a place, but an approach. It is holistic, person- and family-centred, and delivered by a team that may include physicians, nurses, social workers, family, community members, spiritual care providers, and volunteers.  

But making this vision real requires more than awareness. It requires action, system-level change, investment, and collaboration across sectors. 

The Access Gap: A National Challenge 

Canada’s geography, diversity, and decentralized health system create significant disparities in access to palliative care. People living in rural or remote areas often have fewer services available. Indigenous communities, newcomers, and people experiencing homelessness may face additional cultural, systemic, or logistical barriers. Even within urban centres, access can vary widely depending on diagnosis, age, or care setting (CIHI, 2023). 

These inequities are not just logistical, they are deeply human. They mean that some individuals face unmanaged pain, unnecessary hospitalizations, or isolation at the end of life. They mean families may struggle without adequate support, both during illness and in bereavement. 

If we are serious about “Palliative Care Everywhere,” we must confront these disparities head-on. This includes: 

• Expanding community-based and home care services  

• Investing in culturally safe and inclusive care models  

• Strengthening workforce capacity across all regions  

• Ensuring equitable funding and policy alignment across provinces and territories  

Access to palliative care must not depend on where you live, who you are, or what illness you have. 

Continuity of Care: Bridging the Gaps Between Settings 

One of the most critical and often overlooked elements of palliative care is continuity. People with life-limiting illnesses frequently move between care settings: from hospital to hospice, from hospice to home, from home back to hospital or long-term care. Each transition carries risks of miscommunication, gaps in care, or loss of established relationships. 

High-quality palliative care requires seamless coordination across these transitions. Continuity of care should not depend on circumstance; it needs to be built into the system. 

The national Framework for Palliative Care in Canada emphasizes that services must be integrated across settings and providers, supported by shared communication systems and collaborative care planning. Without this integration, patients and families can experience fragmented care at the very moment they need stability and support the most. 

Consider a person receiving care at home who experiences worsening symptoms. If community supports are insufficient, they may be admitted to hospital, not because it is the best place for them, but because it is the only available option. Later, they may wish to return home or move to hospice or a long-term care setting, requiring another transition. 

Each of these shifts should feel like a continuation of care, not a restart. 

To achieve this, we need: 

• Shared care plans that follow patients across settings  

• Strong communication between care teams  

• Consistent access to medications, equipment, and supports  

• Navigation services to guide patients and families through the system  

Continuity is not just a clinical issue. It is a matter of dignity. 

Home, Hospice, and Hospital: Supporting Choice 

Most Canadians say they would prefer to receive care and die at home, surrounded by loved ones. Yet many still die in hospital. This disconnect often reflects gaps in community supports, not personal preference. 

Only about 13% of Canadians die at home with palliative care support, despite growing demand for care in the community (CIHI, 2023). While this represents progress from previous years, it continues to highlight a gap between what Canadians want and what the system is able to provide. 

Palliative home care plays a critical role in improving quality of life at the end of life. Patients receiving palliative care at home often benefit from being surrounded by family and community, with access to a broader range of supports, including pain and symptom management, caregiver support, and greater involvement in care decisions (CIHI, 2023). Evidence also shows that home-based palliative care can reduce reliance on hospital services. In 2021-2022, patients receiving palliative home care spent fewer days in hospital in their last year of life compared to those receiving hospital care only, averaging 18 days versus 28 days (CIIHI, 2023). 

The timing of palliative care also differs depending on where it is delivered. Patients receiving palliative home care tend to be identified earlier and live longer after identification, with half dying within approximately 119 days (CIHI, 2023). In contrast, patients receiving palliative care in hospital are often identified much later, with half dying within just 11 days (CIHI, 2023). This difference underscores the importance of earlier integration of palliative care, particularly in community settings, to improve quality of life and support better care planning. 

Despite these benefits, some individuals are unable to remain at home at the end of life. In 2021-2022, nearly one in four patients receiving palliative home care were transferred to hospital near the end of life, often because the supports required to remain at home, such as timely access to medications, equipment, or specialized care, were not available (CIHI, 2023). In many cases, these hospital admissions occurred specifically to receive palliative care, suggesting that the system is not consistently able to deliver this care in the community, despite the patient preference to die at home (CIHI, 2023). 

Hospices play a vital role in bridging this gap, offering specialized, compassionate care in a home-like environment. But hospice spaces are limited in many regions, and access can vary widely. 

Long-term care homes are also a critical setting for palliative care. For many residents, these facilities are both their home and primary site of care. While long-term care homes are equipped to have access to nursing care and medical support, access to palliative care within these settings remains inconsistent. In 2021-2022, only 34% of residents identified as being in the last six months of life received palliative care, although this represents an improvement from previous years (CIHI, 2023). Additionally, a significant number of residents continue to be transferred to hospital at the end of life, including more than 6,000 residents who died in hospital after being transferred from long-term care (CIHI, 2023). In many cases, these transfers occurred specifically to access palliative care, highlighting ongoing gaps in the availability of services within long-term care settings. 

At the same time, hospitals remain essential for managing complex symptoms and acute needs. In 2021-2022, approximately 44,000 patients were admitted for palliative or end-of-life care, with some of these admissions reflecting limited access to supports in the community (CIHI, 2023).   

These realities highlight the need for a more coordinated system of care. The goal is not to replace one setting with another, but to ensure that all settings are equipped to provide a palliative approach, and that transitions between them are smooth and supported. 

“Palliative Care Everywhere” means wherever someone is, home, hospice, hospital, or long-term care, they receive the same standard of compassionate, person-centred care. 

The Role of Communities and Caregivers 

Palliative care does not happen in isolation. It is deeply rooted in communities and relationships. Family members, friends, and volunteers often provide the majority of care, especially in home settings. 

Supporting caregivers is therefore essential. This includes: 

• Providing education and training  

• Offering respite and mental health supports  

• Recognizing caregivers as key members of the care team  

Community-based programs, such as compassionate communities initiatives, also play a growing role in expanding access and awareness. These approaches recognize that caring for people at the end of life is not just a medical responsibility, it is a social one. 

A Shared Responsibility 

The vision of “Palliative Care Everywhere” cannot be achieved by the healthcare system alone. It requires collaboration across governments, healthcare providers, community organizations, and individuals. 

The Framework on Palliative Care in Canada emphasizes that palliative care is a shared responsibility, one that involves policy alignment, public education, and coordinated action at all levels.  

This includes: 

• Governments investing in sustainable, equitable palliative care systems  

• Healthcare organizations embedding a palliative approach across all services  

• Educational institutions training providers in palliative care principles  

• Communities fostering open conversations about death, dying, and care  

It also includes individuals having conversations with loved ones, engaging in advance care planning, and advocating for better, more inclusive care. 

Moving from Awareness to Action 

National Hospice Palliative Care Week is an important moment for awareness, but awareness alone is not enough. The theme “Palliative Care Everywhere” is ultimately a call to action. 

It challenges us to ask: 

• Why do gaps in access still exist, and what will we do to close them?  

• How can we ensure continuity of care across all settings?  

• What investments and innovations are needed to support care at home and in the community?  

• How do we build a system that truly reflects the needs and values of all Canadians?  

The answers to these questions will shape the future of palliative care in Canada. 

A Vision for the Future 

Imagine a Canada where every person living with a life-limiting illness has access to compassionate, high-quality palliative care no matter where they live or where they receive care. A Canada where transitions between home, hospice, and hospital are seamless. Where caregivers are supported, communities are engaged, and care is guided by what matters most to each individual. 

This is the promise of “Palliative Care Everywhere.” 

It is an ambitious goal, but it is also an achievable one. 

With coordinated action, sustained investment, and a shared commitment to equity and dignity, we can ensure that no one faces serious illness or end of life without the care and support they deserve. 

Because palliative care should not depend on place. 

It should be everywhere. 

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About CHCA

The Canadian Home Care Association (CHCA) is a national non-profit membership organization committed to fostering integrated, person-centred care in home and community settings. The CHCA represents a diverse membership of public and private organizations that fund, manage, and deliver services and products, providing a unified voice to advance excellence in home and community care across Canada. Through advocacy, collaboration, and knowledge sharing, the CHCA champions a vision of a seamless, accessible, accountable, and evidence-informed health care system that prioritizes patients and their families while ensuring long-term sustainability. 

CHCA Website / LinkedIn 

About CHPCA 

The Canadian Hospice Palliative Care Association (CHPCA) — the national voice for hospice palliative care in Canada, is dedicated to the pursuit of excellence in care for persons approaching death so that the burdens of suffering, loneliness and grief are lessened. CHPCA operates in close partnership with other national organizations and continues to work to ensure that all people in Canada, regardless of where they may live, have equal access to quality hospice palliative care services for themselves and their family.  Sign up for CHPCA’s newsletter.

CHPCA Website / LinkedIn