This could be the best place to die in America

Inside a Victorian-era apartment building atop the hills of San Francisco’s Lower Haight neighbourhood, six dying residents go about their days. They swap stories, sip chilled pumpkin rice soup, and take strolls through the garden, if they’re feeling up to it.

The Zen Hospice Project reimagines the experience of dying. Staff and volunteers believe that the best end-of-life care immerses terminally ill patients in the human experience, by delighting the senses, offering comfort and community, and reminiscing on bygone days.

When a terminally ill resident tells the kitchen manager that he’s not hungry for food or drink, but would take a slice of chocolate cake, she whips up a batch of cupcakes.

“This is a moment you have to really enjoy,” Erin Singer, the former kitchen manager at Zen Hospice, told Business Insider in 2015. “We don’t take it that seriously here.”

In 2015, we spent the day at the Zen Hospice Project’s residential care facility, the Guest House, to see what it’s like to live and die there.

On an unusually crisp day in San Francisco, we arrived at the Guest House. It was quiet, save for the pitter-patter of volunteers' feet on the hardwood floors.

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Dying in a hospital (or anywhere outside of the home) is often a clinical, impersonal experience. The patient lies in a white-walled room, maybe alongside a stranger, with nothing to do but listen to the sounds of monitors. Zen Hospice is different.

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At the Guest House, big comfy couches and bay windows by the entrance make it feel like somebody's home.

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The residents rarely stay long. In order to be admitted, an applicant must carry a diagnosis of six months or less to live. Residents come from all over, and most don't practice Buddhism.

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The cost of residency is based on a sliding scale, and the non-profit does not accept insurance or Medicare. But no one is turned away because of their financial situation.

Courtesy of Zen Hospice Project
Katherine, a former resident, and her daughter Marcia share a sit.

Source: Zen Hospice Project

In 2016, residency cost about $US800 a day.

Upon entering, a familiar smell drifted down the hall. We followed it to the back of the house, where the (now-former) kitchen manager, Erin, whipped up a bowl of macaroni and cheese.

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Erin Singer is no longer the kitchen manager at the Zen Hospice Project.

When a resident enters the Guest House, the kitchen manager will meet them to find out their likes, dislikes, and any favourite ethnic dishes.

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'We feed a family of six every day: breakfast, lunch, and dinner,' Erin, the former kitchen manager, said. Her specialties were avocado-chocolate pudding and chicken liver mousse.

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Every plate offers a variety of colours and textures. 'If your big adventure for the day is that meal,' she said, 'let's make it as fun as possible.'

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A volunteer in an oversized cardigan and yoga pants corralled us for a tour. In the dining room, residents' families will often gather for a meal.

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Fresh flowers are always on hand.

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They're harvested from the garden, a tranquil, private hideaway. Here, the Guest House's most sacred ritual takes place -- the flower petal ceremony.

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When a resident dies, the mortuary attendant wheels the body onto the patio and friends, family, and volunteers gather around.

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Guests are invited to share a few kind words or memories and toss a handful of flower petals onto the body. If there is no family, staff will always participate.

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'The ritual takes on a life of its own, depending on where the family is at,' Roy Remer, director of education and training, told us. 'Sometimes the stories are joyful, sometimes there's complete silence.'

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Onward with the tour. We discovered an eclectic art collection strewn across the house. Many pieces were created or donated by former residents.

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Chairs were stacked in the hall to accommodate groups of visitors. Unlike in a hospital, the staff welcomes non-relatives to stay at a resident's bedside, so long as they don't disturb others.

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A black banner hung on the door, indicating a resident had recently died. The Japanese script says something to the effect of, 'without physical form, there is no emptiness.'

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Inside the main room, volunteers gathered for a shift-change meeting, which began with a 10-minute meditation. Afterward, each person shared a reflection.

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The day before, a resident renewed vows with his wife. Later, the wife came downstairs and sat with Jeanne, a volunteer, while she arranged flowers. They talked about relationships and what they meant -- the highlight of Jeanne's day.

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One volunteer vowed to stop belittling his problems by comparing them to those of the residents. Another described his struggle to let things be as they are.

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Each volunteer knew the names and personalities of the residents upstairs. In cases where there is no family, they become like surrogate sons and daughters.

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Barbara, another volunteer, admitted to feeling old lately and not liking it very much. She said she couldn't keep up with the young people in her taiko drumming class.

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Barbara joined Zen Hospice Project around the time her mother died. She said she remembered thinking, 'I want to be with people who are dying, then I will know all about death and be prepared for it. ... I'm still scratching my head.'

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When the meeting came to a close, a volunteer offered to take us upstairs, where the residents sleep and spend a majority of their time. No one felt up to talking that day.

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In an empty room, recently slept-in sheets lied in a crumpled pile on the bed. The TV played a foreign language show.

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Spiritual imagery hung on the walls, though most guests are not Buddhist, according to a volunteer.

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Still, they choose the Guest House because they want to feel connected. To their senses ...

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... and to each other.

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Barbara, a volunteer, carries the leaves from out front to a compost pile behind the Guest House.

One volunteer told me that the day before my visit, a resident got up to take a walk when he realised a flower petal ceremony was about to start on the patio.

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Instead of taking his walk, he stayed to observe and honour the memory of his former housemate. It was moving to see, said the volunteer.

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For residents and staff alike, the Guest House is a place to live fully.

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