Palliative & End-of-Life Care

Overview

Palliative and end-of-life care represents a significant and growing service line for TheKey, encompassing comfort-focused home care for clients with serious illness, hospice support, anticipated death protocols, and caregiver/family bereavement. In the Canadian market the term "palliative" is preferred over "hospice," while U.S. operations use both terms interchangeably. This area matters operationally because it involves specialized staffing, clinical supervision, referral partnerships, caregiver emotional support, HR policy (bereavement ROEs), and active sales account management — touching nearly every department in the company.

---

Key People

• Timothy Thomas — Early champion of palliative home care, Home Care Assistance Montréal; coordinated with CHPCA, drove website content, and built out the palliative care service offering from at least 2015. [Palliative Home Care — 2018-12-06]
• Maria Licoudis — Palliative care nurse supervising caregiving staff in Montréal; also engaged on anticipated death protocols. [Palliative Home Care — 2018-12-06; Fwd: Question re Trina — 2019-12-04]
• Phil Chanda / Tim Thomas — Flagged the "hospice vs. palliative" terminology issue on thekey.ca in 2023. [Re: TheKey.Ca — 2023-12-19]
• Kathryn Nester — Organized optional grief and bereavement training (PalCare, 2024); provided HR guidance on caregiver bereavement ROE requests. [Optional Grief and Bereavement Training — 2024-05-15; Re: Caregiver's Requesting ROE — 2025-05-01]
• Carolyn Daoust — Raised the caregiver ROE-for-bereavement question to HR. [Caregiver's Requesting ROE — 2025-05-01]
• Celeste Lee — End-of-life doula with 7 years facilitating the End-of-Life Doula Care Program at Douglas College; connected with TheKey late 2025. [Fwd: Fw: Thank you! — 2025-12-17]
• Ashley Alford / Pat Echols — CSM/Caregiver Managers handling hospice/end-of-life client intake in the U.S. Midwest. [SOC Email — 2026-02-06]
• Sandra Daoust — Operations Manager (Montréal); circulated articles on palliative care and assisted dying. [Interesting article — 2016-05-18]

---

Processes & Policies

Service Delivery Model

• Palliative home care in Montréal is supervised by a palliative care nurse (Maria). PABs (Nurses Aides) deliver comfort care; LPNs handle clinical tasks. [Palliative Home Care — 2018-12-06]
• Comfort care tasks include lip-sponging, positioning, advising nursing staff of changes, and one-on-one companionship. [Re: Client Information — 2018-11-14]
• When working alongside hospital-based palliative programs (e.g., Mount Sinai, Royal Victoria), the client must first be accepted by the facility's palliative service; TheKey then provides supplemental one-on-one support. [Re: Home Care Assistance — 2017-12-07/08/11]
• Some palliative care centres restrict outside providers; site confirmation is required before placement. [Re: Home Care Assistance — 2017-12-07]

Caregiver Matching for End-of-Life Clients

• Caregiver preference for end-of-life cases: experienced in hospice/EOL care, compassionate, focused on comfort. [SOC Email — 2026-02-06]
• Sales intake captures whether a client is currently receiving hospice services and the name of the hospice company. [ASSESSMENT SCHEDULED: Ron Meldrun — 2026-01-22]
• TheKey Sales Process requires collecting additional care context (PT, OT, hospice) during initial intake. [TheKey_Sales_Process_Final.txt]

Anticipated Death Protocol

• Maria Licoudis raised a clinical question in 2019 about whether caregivers should call paramedics or the coroner at an anticipated death, indicating this protocol was not yet fully documented. [Fwd: Question re Trina — 2019-12-04]

Referral Partnerships

• Hospice and palliative care accounts are active referral targets; at least one U.S. account (unnamed, 2025 growth plan) sought quick-turnaround staffing for hospice/palliative patients. [2025 Site Weekly Growth Activity Actions Plans.xlsx]
• Referral source categories explicitly include "Hospice" in TheKey's SAP account tracking. [Priority_Zip_Code_SAP_Overhaul_Playbook.txt]
• VCH Home Health and Calgary Home Care direct lines both include palliative care within their community nursing services. [VCH_to_Home_Recovery.txt; Calgary_Home_Care_Access.txt]

Caregiver Bereavement — HR Policy

• Per the 2014 Employee Handbook: up to three days of unpaid bereavement leave upon death of an immediate family member; days need not be consecutive. [Employee_Handbook_2014.txt]
• Caregivers losing a client (not a family member) are not entitled to bereavement leave. ROE issuance for client-death bereavement has no current mechanism. [Re: Caregiver's Requesting ROE — 2025-05-01, Kathryn Nester]

Training

• PalCare's 3-day Grief and Bereavement training offered optionally to staff (May 31–June 8, 2024, Margaret Bahen Hospice, Newmarket). [Optional Grief and Bereavement Training — 2024-05-15]
• CareAcademy launched a Hospice Care Curriculum for end-of-life care training (2024). [Last Chance to Register — 2024-02-26]
• A 2023 webinar with hospice pioneer Barbara Karnes (via HCP) addressed staff preparedness for the dynamics of dying. [Reminder: Your Webinar — 2023-07-19]

---

Timeline & Key Events

| Date | Event |

|---|---|

| 2015-04 | Timothy Thomas engages CHPCA for National Hospice Palliative Care Week promotion; Montreal palliative home care page goes live. |

| 2015-05 | Thomas and colleagues attend/submit to 2015 Canadian Hospice Palliative Care Conference (Ottawa). |

| 2016-05 | Sandra Daoust circulates article on palliative care and assisted dying. |

| 2017-12 | Inquiry from Julien HT Wu clarifies TheKey's supplemental role alongside hospital palliative centres. |

| 2018-12 | Palliative home care model in Montréal formalized with nurse Maria supervising PABs and LPNs. |

| 2019-12 | Maria Licoudis raises unresolved anticipated-death protocol question. |

| 2023-07 | Staff webinar with Barbara Karnes on dynamics of dying. |

| 2023-12 | Phil Chanda and Tim Thomas flag "hospice vs. palliative" terminology on thekey.ca; Maria agrees to change. |

| 2024-02 | CareAcademy Hospice Care Curriculum unveiled. |

| 2024-05 | Optional PalCare grief/bereavement 3-day training offered to staff. |

| 2025-05 | Caregiver ROE-for-bereavement issue escalated to HR; no resolution found. |

| 2025-12 | Celeste Lee (EOL Doula, Douglas College) connected with TheKey. |

| 2026-02 | Active end-of-life client intakes documented in Winnipeg and U.S. Midwest. |

---

Key Decisions

• "Hospice" → "Palliative" on thekey.ca (2023-12): Phil Chanda, Tim Thomas, and Maria agreed to replace "hospice" with "palliative" sitewide to align with Canadian terminology standards. [Re: TheKey.Ca — 2023-12-19]
• Supplemental (not primary) model at palliative facilities: TheKey positions itself as an add-on provider to hospital/facility palliative programs, not a replacement; client must be enrolled in the facility's program first.
• Caregiver bereavement for client deaths: no ROE issued. HR confirmed no mechanism exists; caregivers grieving client deaths are not eligible for bereavement employment insurance under current policy. [Re: Caregiver's Requesting ROE — 2025-05-01]
• Advocacy stance (2020): Phil Grant's forwarded communication reflects an organizational awareness that viable home care and palliative alternatives are preferable to expanded assisted-dying options — relevant to public positioning. [little favour — 2020-01-25]

---

Open Questions & Gaps

1. Anticipated death protocol: As of 2019-12, no documented standard existed for whether caregivers call paramedics or a coroner at an anticipated client death. Current status unknown. [Fwd: Question re Trina — 2019-12-04]

2. Caregiver emotional support after client death: HR policy does not accommodate ROE or EI for caregivers; no formal support program documented beyond optional training. The nature-of-industry argument was raised but not resolved. [Re: Caregiver's Requesting ROE — 2025-05-01]

3. Website terminology audit completion: It is unclear whether the "hospice → palliative" change on thekey.ca was fully executed following the 2023-12 decision.

4. End-of-life doula integration: Celeste Lee's connection (2025-12) is promising but no formal partnership or program role is documented yet.

5. BEREAVE/St. Croix Hospice tool: Referenced as a bereavement support platform (2025-09, 2026-01) — unclear whether TheKey is evaluating or piloting this technology.

---

Related Topics

• Caregiver Recruitment & Matching
• HR Policies & Leave Management
• Referral Account Management (SAP/Hospice Partners)
• Clinical Supervision & Nursing Roles
• Grief & Bereavement Support Programs