Construction officially started on a residential facility providing end-of-life care outside a hospital, which will be the first of its kind in Canada—one that has been designed to suit specific Jewish community needs.
Groundbreaking took place on Friday for the 12-bed, 21,926-square-foot facility called Neshama Hospice, which is scheduled to open in late 2026.
Planning has been in the works since 2016. The properties in the Bathurst Street and Wilson Avenue area were purchased in 2018. Initially, the hospice planned to welcome patients starting in 2021—but both fundraising and construction were delayed by COVID.
But the pandemic opened up a national conversation about how people talk about death, says the chair of the board at Neshama Hospice.
“COVID really brought death and dying into the vernacular. People are way more open to talking about end of life. COVID taught us a lot about what shouldn’t happen when someone lives out their final days,” Mindy Herman said.
“COVID was really a turning point in why hospices and why hospices now,” said executive director Lisa Kronenberg, who also talked to The CJN before the groundbreaking.
“Dying during COVID unfortunately, was not a pleasant experience. Dying in emergency rooms or in acute (care) beds, dying alone. Nobody should die alone. We learned from that.”
Most Canadians say they don’t want to die in a hospital, but for many families, that’s not feasible, either financially or emotionally, Kronenberg says.
Home health care is expensive. Family caregivers can burn out and not have the ability to cope when equipment breaks or patients’ pain can’t be managed.
It’s not uncommon for an older couple to be looking after each other until there’s a crisis and someone ends up in emergency and “then bad things happen,” said Kronenberg, who saw this scenario as a social worker.
Herman says her own mother is a perfect example of the need for hospice care. Her parents had been in an assisted living residence and her mother couldn’t return home after being hospitalized. “She got stuck in an acute care bed in the hospital and it was not a positive experience,” Herman said.
“With my mother, all we were focused on were her vital signs. We needed someone else to take care of her, so we could be her daughters and we could be there as her children,” Herman said. “In hospice, the staff are caring for the patient 24-7, so the family and loved ones can be there, the way they should be.”
COVID was also a lesson for the province’s ministry of health, which funds a hospital system that was already stretched thin before the pandemic even hit.
Hospice care is a significant savings to the health care system. In 2014, the Ontario Auditor General’s Report showed that end-of-life care in hospital was $1,100 a day compared to $460 a day for hospices. Moving patients to hospice care also frees up scarce beds for those who need hospital resources.
“One of the things that’s really gratifying to see is a newfound interest in investment at the provincial ministry of health,” Kronenberg said.
“The ministry just announced more hospice beds in the province. There’s a start toward investment in grief and bereavement (counselling) and that’s huge for… Neshama’s patients and families, because our care won’t stop at the door. Our care will follow families and loved ones and grieving is hard and providing those emotional and psychosocial supports—that ultimately will increase the mental health and wellbeing of our communities.”
Neshama means ‘soul,’ in Hebrew and the hospice intends to care for the whole person and their family, said Herman. “It’s not just about pain management that you would get in an acute care hospital, it’s about the essence of the person.”
The average length of stay will be about two to four weeks, and the hospice expects there will be a brisk demand for beds. Neshama will be the first hospice in the North York area of Toronto, and it is being built in a community with an aging population—although not only elderly people need hospice care.
Capital costs for the facility, which include everything from the $6 million purchase price of the properties to the medical equipment, are about $30 million, up significantly from a pre-COVID estimate of $18 million, with the province contributing about $2.5 million. Fundraising is nearly complete, anchored by a $5 million donation from the Ganz family, whose name will be on the building.
The province will contribute 50 percent of the operating costs, leaving the community to raise close to $2 million annually, Herman said. Neshama is funded for 10 beds, but the hospice is adding two more beds during construction, with hope that the province will eventually cover all 12 beds. The considerable financial burden on communities, explains in part, the scarcity of hospice beds in the province, Herman said.
One of the thornier issues the board has considered is its approach to Medical Assistance in Dying (MAID), which has been legal in Canada since 2016. The subject is deeply divisive in the Jewish community, with most Orthodox rabbis opposing it.
After consulting both religious and medical experts, the hospice decided to make MAID available on its premises, if requested, but would call in outside resources. Neshama’s own staff won’t provide it, Herman said.
Patients would not, however, be transferred out for MAID, which has happened at some Jewish other nursing homes. “Transfer is the opposite of being compassionate,” Kronenberg said.
Herman expects that not many patients, who arrive with just a few weeks left to live, will realistically be in a position to request MAID. “And we believe that with excellent care, that won’t be a common request. Sometimes people request it just to feel a sense of control over their lives,” she said.
The hospice is located on a quiet residential street, halfway between the Jewish communities that stretch both north and south on Bathurst Street.
As a Jewish facility, it will have kosher kitchens and be Sabbath-accessible as well as celebrate the holidays. However, it is open to everyone in the community, and will have places for non-kosher food to be eaten.
Each of the 12 single rooms has room for someone to sleep over, a fridge and a washroom. The rooms also open to private patios. At the heart of the main building is a large family room where holidays or milestones can be celebrated and families can interact with others.
“The Jewish community does end of life and grief and bereavement super, super well,” said Kronenberg. “We have shivahs, we have Kaddish groups. We have that ethos of community support and that’s really the ethos that we’ve embedded into Neshama and we’re bringing that to the Jewish community and we’re bringing that to all.”
