Ontario should be a leader in palliative care. But that will never happen unless the provincial government makes it a genuine health care priority and follows its own palliative care framework.

The latest data on the state of palliative care in Ontario isn’t great. If anything, the newly published Palliative Care Atlas from Pallium Canada and McMaster University suggests there are glaring gaps the province needs to close urgently.

Topping the list of problems is Ontario’s shortage of hospice beds. Right now, the Atlas shows Ontario has only half as many palliative care beds as it’s supposed to have in hospices or continuing care facilities. If we count hospital-based in-patient palliative care unit beds, Ontario is still 33 per cent short of its minimum target. In a province with a GDP of almost $890 billion and a health-care budget that tops $91 billion, this situation is inexcusable.

Ontario isn’t falling short in palliative care because it can’t afford anything better. It’s falling short because palliative care hasn’t been a high enough priority for provincial governments of all stripes going back decades. Although Ontario adopted a provincial framework for palliative care in 2021, subsequent public reporting from the province on implementation and outcomes is either non-existent or near impossible to find.

Granted, Ontario’s 2024 budget trumpeted adding 84 hospice beds by 2027. While this is a positive move, announcements are neither a long-term strategy nor a solution. To make matters worse, there was no mention of palliative care or hospice beds in the 2025 budget the provincial government introduced last month.

So, how would it look for Ontario to prioritize palliative care and fill the existing gaps that mean our loved ones needlessly suffer?

Firstly, the province would ensure that palliative care — often incorrectly associated with the very end of life — would come at diagnosis of a life-limiting or life-threatening illness or condition. Instead, many Ontarians receive palliative care late or not at all. Timely, high-quality palliative care not only addresses care needs, which increase with our aging population, but also can support a better functioning health-care system in a cost-effective way.

For one, receipt of palliative care at home or other residences can help minimize patients ending up in the emergency room or intensive care unit. Some Ontario communities train paramedics to provide palliative care at a patient’s home, rather than requiring transport and admission to the ER. But no formal strategy or initiative exists to make this a provincewide reality.

Secondly, Ontario would also have a formal strategy for rural and remote palliative care. These are precisely the regions where the most significant palliative care gaps and inequities exist. In northwestern Ontario, for instance, with its many rural and remote communities, there is just one specialist palliative care team based in Thunder Bay. Most hospitals in this region do not have access to specialist palliative care services or 24-hour consultation.

Finally, the province needs a formal strategy with dedicated funding to improve palliative care for particularly underserved populations, including homeless and marginally housed, incarcerated persons, infants and children, Francophones and others.

Pioneering work in some areas has happened in Ontario, notes the Atlas, which the province could use as a springboard for a provincewide strategy. Of note is that the Ontario Atlas does not assess Indigenous palliative care provision, but a dedicated Atlas for and by Indigenous peoples is in the works.

All provinces and the federal government should support — and fund — its development, as existing research highlights the significant gaps and inequities existing in palliative care for Indigenous populations, including those in rural and remote communities.

The Ontario Palliative Care Atlas is a wake-up call for the provincial government. Frameworks, commitments, and budget announcements are all good, but they mean little if the government doesn’t genuinely make palliative care a priority. Had Ontario been putting its words into action years ago, it would already be a palliative care leader in Canada, if not the world.

• Rebecca Vachon is the program director for Health at Cardus.