Skip to content

Coastal Palliative Care

Supportive care, Palliative care and Hospice services for Coastal


Forms and information for Physicians. (resources and articles at bottom of page)

Palliative Care Benefits application

NS Palliative & Supportive Care criteria

NS Palliative & Supportive Care referral

No CPR form

TB Screening assessment form

Expected death in the home

Whistler/Pemberton Palliative Program referral

Squamish Palliative Program referral

NS Hospice -Community admission process

NS Hospice admission criteria

Hospice admission checklist

Regional Hospice admission agreement (includes NS Hospice)

Equipment rental agreement for NS (must accompany order form for equipment)

NS Palliative Benefits order form (disposables)

NS Palliative Benefits order form – equipment (nurses)

NS Palliative Benefits order form -equipment (OT)

To refer a patient to North Shore Hospice:
1 Refer patient to N.S. Palliative program with a note requesting Hospice waitlisting.
2 A Palliative Care Physician will assess the request and if appropriate the patient will be added to the waitlist.
3 Patient or POA must sign the admission agreement prior to being placed on waitlist
4 GP will be notified of patient’s status on the wait list.

Criteria for acceptance to NS Hospice
Prognosis must be 12 weeks or less and the patient is unable to remain at home.
The patient must be registered on the N.S. Palliative Care Program and have a no CPR in place.
Patient and family must accept and understand the purpose of hospice care.
Patient must not be receiving IV medications or PEG feed or require regular tests.
Patient must not be a wandering risk or have any history of unprovoked violent or aggressive incidents.
If a patient’s condition stabilises, a family meeting will be held after 8 weeks at the Hospice and plans will be made for patient to transfer either home or to a residential facility.



Information and handouts for patients/families (link)

Information and resources for residents and families in Residential Care – (Daisy Program) (Link)

Resources and articles or videos of interest

Talk to me – Seriously ill patients views on physician behaviours that influence quality of end of life communications (video)

Improving decision making involving frail elderly (video)

DNACPR information (video)

Ten steps for what to say and do (video – Diane E Meier)

The Serious Illness conversation (Bernacki)

The impact of dementia on families

Antimicrobials at end of life

Association between frailty and 30 day outcomes

Communication for physicians

Difficult conversations & heart failure

Polypharmacy for physicians

Bearing bad news

Antipsychotic use for treating delirium

Daisy program brochure

MOST brochure for residents and families

Ashleigh Witt – article re elderly in ED

Autonomy and control in RC

Frailty scale and dementia staging

Residential care terminal orders

SPICT identification tool

Difficult conversations for young adults

Messaging Palliative care (article)