Palliative Care in BC: Still Too Dependent on Where You Live

Written by Clare Koning RN, PhD | April 2026

British Columbia has more hospice beds per capita than almost anywhere else in Canada. By that single metric, it exceeds national benchmarks. But the number of beds in a province is not the same as equitable access to quality end-of-life care, and for many British Columbians, particularly those in rural communities, those with non-cancer diagnoses, and those from Indigenous and other marginalized backgrounds, the gap between what is available and what is accessible remains wide.

The 2024 British Columbia Edition of the Canadian Atlas of Palliative Care, developed in partnership with regional palliative care leaders from across the province, highlights both strengths and significant gaps in BC's palliative care system, mapping disparities in service availability across health regions and identifying populations for whom access to compassionate, coordinated end-of-life care remains inconsistent. Pallium Canada

A 2025 Knowledge Exchange Series convened by the BC Palliative Care Research Collaborative, bringing together people with lived experience, community organizations, clinicians, researchers, and system leaders across BC, found that while equity in palliative and end-of-life care is gaining attention, many communities continue to face significant barriers to access. Healthyagingcore

That phrase, gaining attention, should give health system leaders pause. Attention is not integration.

The Hidden Inequity in How Eligibility Is Determined

One of the most consequential but least visible problems in BC's palliative care system is the structure of the BC Palliative Care Benefits (BCPCB) program itself. A 2024 policy analysis published in Policy, Politics & Nursing Practice examined how eligibility is determined, and found serious problems.

The BCPCB program produces vague, discriminatory, and ableist prognostication practices through its eligibility policy. By privileging observable physical symptoms over less visible social, psychological, and existential suffering, the program discriminates against patients with diagnoses whose symptoms are less immediately apparent, including some chronic conditions, frailty, and mental illness, leaving them less likely to access funded palliative supports despite equivalent need. PubMed Central

This is a policy design problem with a policy solution. It requires the kind of sustained clinical-policy advocacy that does not happen on its own,

it requires organizations with the mandate, the evidence base, and the provincial relationships to push for change across the full arc of the reform cycle.

Where Community Capacity Changes Everything

The BC Centre for Palliative Care works with partners across the health system, community sector, and research institutions to enhance access to high-quality palliative care in all care settings, providing education opportunities and resources for healthcare professionals and students from all disciplines, working with health system partners to test and spread evidence-based interventions, and supporting community-based organizations with seed grants, training, toolkits, and coaching to provide emotional, social, practical, and spiritual support closer to home. Bc-cpc

The population-level impacts of this work are significant. Thousands of healthcare providers trained in culturally safe advance care planning. Hundreds of Compassionate Community initiatives across BC. Tens of thousands of public participants engaged with resources and education on serious illness, death, and caregiving. Each of these represents not just a program delivered but a community made more capable of supporting its members through serious illness, reducing crisis-driven emergency visits, preventing avoidable hospitalizations, and improving the quality of dying in settings where people actually want to be.

The Federal Opportunity and the Accountability Gap

The Canada–BC Aging with Dignity bilateral funding agreement commits to improving the quality of dementia care, palliative, and end-of-life care in long-term care through implementation of evidence-based practice, standardized education, and quality monitoring, with federal investments structured across 2023 to 2029. Canada.ca

This is a real funding opportunity attached to a real accountability framework. But the history of federal-provincial health funding is full of commitments that were absorbed by general health authority operations without measurable change at the point of care. Translating this funding into meaningful palliative care integration across home, long-term care, and community settings requires sustained provincial coordination, organizations that hold the standards, distribute the education, monitor the outcomes, and keep the evidence base connected to the implementation.

The question for health system leaders is not whether BC should invest in palliative care integration. It is whether the governance architecture currently in place is sufficient to make federal commitments real for patients and families in every corner of the province.

For many communities in BC, the answer is not yet.

The BC Centre for Palliative Care, operating under IHSTS governance, is BC's provincially funded centre of excellence for palliative care innovation and education. Learn more at www.bc-cpc.ca.