In December 2024, IAHPC leadership announced its decision to amplify its support for palliative care at the national level by supporting national palliative care associations. In keeping with this commitment, we bring you a pair of articles that highlight caring for Indigenous populations, a topic that the Canadian Hospice Palliative Care Association will focus on in its upcoming conference—and one family's experience of a member of an Indigenous tribe in Canada who received hospice care.
An Inuit marker, an inukshuk, is one of three images the CHPCA is using for National Hospice Palliative Care Week.
Culturally Safer Care: Pause, reflect, share... then move forward
"We've heard from many folks that access to palliative care can be tricky for people in more remote and rural communities," says Karine Diedrich, acting co-CEO of the Canadian Hospice Palliative Care Association (CHPCA), a lifetime member of the IAHPC. "With many indigenous communities being remote, it stands to reason that this factor—combined with being a historically marginalized cultural minority—makes it difficult to access specialized and culturally safe care."
More than 1.8 million Indigenous people live in the country, accounting for 4.9% of the population.
"We recognize that participation in the conversation is key, which is why we’re introducing the new dedicated stream at this year’s national conference in October: Indigenous Communities & Culturally Safer Care," says Diedrich. "It is intended to promote and grow Indigenous-led content, such as highlighting land-based healing, traditional knowledge, and community engagement."
Recognize past wrongs
It is essential to first recognize historical and ongoing wrongs suffered by Indigenous peoples in Canada in order to provide culturally appropriate palliative care, says Donna Flood, executive-director of the Prince George Hospice Palliative Care Society.
Flood states that local wrongs include dozens of mainly Indigenous missing and murdered women along British Columbia's 447-mile-long "Highway of Tears," and the discovery of unmarked Indigenous children's graves of those forcibly removed from their families and sent to residential schools. "It was a pivotal moment in seeing the grief of Indigenous people in a different way," says Flood.
Some useful resources
- First Nations Hospice Association: End-of-Life Journey. Also: Elder Wellness, which includes a section on dementia. Both are free.
- Canadian Virtual Hospice's Living My Culture Indigenous safety training. Also, a webinar on April 2, 2025, on Supporting Health Ways of Living Through Grief and Loss: Indigenous Perspectives on the Connections Between Birth & Death. Both are free.
- San'yas Indigenous Cultural Safety Training Program. Paid.
- University of Alberta's Faculty of Native Studies has continuing education courses. Paid.
A goal is to avoid layering fresh grief (a death) on top of existing grief. "We have a spot where people can pause and reflect...share, and move forward," she adds. "We train facilitators how to open the dialogue" and how to offer a pause that allows families "to do what they want to do."
As executive-director of the B.C. Hospice Palliative Care Association, Pablita Thomas's job is ensuring that provincial and national partners speak to each other, to be effective. The association collaborates with the province's First Nations Health Authority, a unique, self-governed body that provides health care services, training, and financial support for Indigenous peoples in the region.
To be a good partner, listen
"I think that the important piece is that we need to be partners in care," says University of Northern British Columbia researcher and Associate Professor Shannon Freeman. "To listen first...recognize that they are a diverse group with many different and unique experiences, have unique values, and different priorities. Educate yourself as much as you can, and recognize that it is an interactive journey, a process. We talk about safer care, not safe care."
Thomas concurs. Having the Indigenous communities "lead the conversation, with us as supporters," she says, "is where I've seen huge strides."
Flood notes that "if you know how to care for one Indigenous group, you know how to care for just that one group." The best advice is to "stop and listen, be present."
'I'll Be Forever Grateful': How a Northern hospice gets it right
Cheyanne and Zach on their wedding day, with Mary and Elvis. Pets, like Elvis, are welcomed to live with their owners while in hospice. Photo by Tangena Edmunds. Used with permission.
No two people could have been closer than Cheyanne and her great-grandmother, Mary, who raised her from the day she was born. When Cheyanne went house-hunting with her fiancé, Zach, they chose one with a suite so that Mary could live there too.
"We were inseparable," says Cheyanne, until Mary's health, at age 78, began to falter. Short hospital visits became increasingly longer, ending three years later when Mary entered Rotary Hospice House in their city of Prince George, Canada.
In the heart of heavily forested British Columbia, at the confluence of the Fraser and Nechako rivers, the Lheidli T'enneh have lived in this region for at least 9,000 years. Prince George eventually grew from a fur trading post established in 1807.
The hospice serves a significant and richly varied Indigenous population and does so consciously. (Mary Dolores Elizabeth Prest belonged to Skwah First Nation.) Supplying culturally safe care to every person "is the way we've always worked," says Donna Flood, executive director of the Prince George Hospice Palliative Care Society, which runs a home care program and the hospice. "To care for someone, you need to know the uniqueness of that person. There is no 'one size fits all.'"
Cheyanne and Zach had already moved up their wedding date by months, so that Mary could walk Cheyanne down the aisle. But it became clear that date wasn't soon enough. "I couldn't picture my wedding without her," says Cheyanne, so on Mary's second day in hospice, she asked her, then hospice staff, if she could arrange a ceremony in Mary's room the next day.
Mary argued against it, saying, "I don't want to ruin your wedding day!" Cheyanne countered with, "I need you there."
Hospice staff agreed, but suggested that the ceremony be held in the light-filled common room instead. "It feels like a big, beautiful living room," says Cheyanne, with ample space to now invite family members to the ceremony. Then the staff asked, "What does Mary like?" "Greenery," said Cheyanne.
When she arrived early next morning, "I was in shock! They had grabbed all the plants they could find and placed them behind where Zach and I would be standing." White roses graced the tables, covered with white cloths, and rose petals adorned her path to the officiant.
Then, exactly as Cheyanne hoped, she and Mary went up the aisle hand in hand (thanks to a family member who pushed Mary's wheelchair).
Mary died within a couple of weeks. "She went out on her own terms," says Cheyanne. At the hospice she listened to her favourite music, enjoyed her favourite cocktail, and had the company of her dog, Elvis. "We all felt so supported at the hospice. They were checking on us, making sure we were eating, offering meals."
In-house grief counsellors made a difference. At a time when Cheyanne was losing her most precious family member, "It felt like it was a family supporting you."
"They just treated my grandma with such respect, and kept her pride and dignity. They never treated her as a sick person. I'm so grateful for them allowing her to be herself to the end. I'm in awe of them; I'll be forever grateful."
Rotary Hospice House is grateful too, as since Mary's death in 2023, Cheyanne fundraised the most in two years—$10,000—in its annual 100-kilometre-walk challenge.
Cheyanne has become a hospice advocate who loves every opportunity to talk about her great-grandmother, and how the hospice not only cared for Mary, but brought moments of joy to her end-of-life journey. The hospice helped Cheyanne and Zach Toninato's dream come true of a wedding with Mary participating. Photo by Tangena Edmunds. Used with permission.