Advance Care Planning Is Not About Death. It's About Not Wasting the Health System's Most Expensive Moments.

Written by Clare Koning RN PhD | May 2026

The most expensive care in any health system tends to cluster at two ends of the life course: birth, and death. We have built considerable infrastructure around the first. The second remains systematically underserved, poorly coordinated, and, in too many cases, contrary to what patients actually want.

This is not a values argument, though values matter. It is a system design argument. Lived experience has shown us that advance care planning decreases life-sustaining treatment, increases use of hospice and palliative care, and prevents hospitalization. A 2024 study published in the Journal of the American Geriatrics Society, examining Advanced Care Planning (ACP) completion across 11 high-income nations, found that ACP has been shown to reduce end-of-life hospitalization and costs while supporting families during surrogate decision-making and bereavement.

Research on advance care planning programs finds average savings of $9,500 per patient in the last year of life, with evidence of reduced ICU use, reduced length of hospital stay, and better alignment of care with patient preferences.

These are not marginal gains. At the scale of BC's aging population, a province with a growing shortage of long-term care beds, projected to reach a deficit of 16,000 beds over the next decade, the population-level value of preventing avoidable end-of-life hospitalizations is enormous.

Why It Still Doesn't Happen Consistently

Advance care planning in BC is uneven. It depends heavily on whether a patient has a family physician willing to initiate the conversation, whether their primary care team has been trained in culturally safe ACP approaches, whether their community has access to the education and resources that help people understand their options, and whether any documentation created is findable and usable at the moment it is actually needed.

Research from NCBI on the evidence base for ACP identifies exactly this: patients in their last year of life continue to experience unscheduled hospital admissions and multiple specialist visits not because their wishes were unknown, but because the systems to honour those wishes, documented preferences, accessible records, coordinated community care, were not in place. An ambulance crew responding to a crisis has no time to locate an advance directive that exists only in a paper file in a GP's office.

A 2024 JAMA Internal Medicine randomized clinical trial of 64,915 older patients found that while a primary care-based ACP initiative increased documentation of end-of-life preferences, it also found variation in outcomes – showing that documentation alone is insufficient. Advance care planning works when it is embedded into continuous care relationships, supported by community resources, and connected to real-time care delivery systems.

What the BC Centre for Palliative Care Has Built

The BC Centre for Palliative Care, operating under IHSTS governance, has spent over a decade building exactly this infrastructure. Thousands of healthcare providers trained in culturally safe advance care planning. Hundreds of Compassionate Community initiatives connecting community organizations with clinical services. Public-facing resources that normalize conversations about serious illness before crisis arrives.

This is not soft work. It is the connective tissue between a documented preference and a care experience that honours it. The evidence on Compassionate Communities specifically, a model pioneered in the UK and now spreading globally, finds that communities with active death literacy and peer support infrastructure have lower rates of crisis-driven acute presentations, better caregiver outcomes, and improved community capacity to support people through serious illness outside hospital walls.

The Federal Funding Window Is Closing

Canada's bilateral Aging with Dignity agreements with BC, which include explicit commitments to improving palliative and end-of-life care in long-term care through evidence-based practice, standardized education, and quality monitoring, begin winding down after 2026–27. Budget 2026 confirmed $447 million through this agreement in the current fiscal year.

The question for health system and Ministry leaders is whether that federal investment is being used to build lasting infrastructure, trained providers, documented preferences, connected community and clinical systems, or whether it is funding a period of activity that will not outlast the agreement.

Advance care planning at scale is not a project. It is a system function. Treating it as the former is how BC ends up, in five years, with the same proportion of people dying in settings they would not have chosen, consuming acute care resources in their final weeks that serve neither their wishes nor the system's sustainability.

The infrastructure to change this exists in BC. The question is whether the policy and funding decisions around it are commensurate with the scale of what is at stake.

The BC Centre for Palliative Care, supported by IHSTS, leads BC's provincial advance care planning and palliative care integration work. Learn more at bc-cpc.ca and ihsts.org.