Maria Brown Pisani wants to die at home - and she shouldn’t have to fight for the privilege.

The 52-year-old mother of two has breast cancer that’s spread to her bones and lungs. She has fractured her pelvis, and has pain in her hip and tailbone. She’s been hospitalized twice in the last three weeks to drain fluid from her lungs and is on oxygen 24 hours a day. She can barely walk and needs help getting to the bathroom.

Her palliative care doctor has told her that she could die at any time, from today to October. Yet she pronounces her dire prognosis without a hint of self-pity.

“I’m hoping to defy them all,” Pisani vows. “I’m not ready to go to a hospice yet. I want to go home.”

For the past month she’s been living with her sister in Vaughan while renovations have been going on at her Scarborough house; her bathroom was leaking and toxic mould was discovered behind the walls. While at her sister’s, she had to be hospitalized twice. When she was discharged, Pisani began receiving 49 hours a week of assistance through the local Community Care Access Centre (CCAC) - a personal support worker came for an hour twice a day as well as overnight during the week.

Now the renovations are done, her kids are set to go back to school, and she wants to get back home. But she’s discovered that in Scarborough, the maximum she can receive is 21 hours of assistance, less than half of what she was getting in Vaughan. She’s been shocked to learn the availability of home care services depends on your catchment area and every location can be different.

So now Pisani is forced to use her last breaths to fight for fairness.

“I’m disgusted by this,” she says. “Areas around us like North York, East York, Toronto, and Vaughan get better service for palliative care while we, in Scarborough get shortchanged. Why?

“Are we, the residents of Ontario, not all equal and a part of the same health-care system? Why do some residents get more services than others? Where is the equity?”

There are 14 provincially-funded CCACs that oversee home care but there’s no consistency in service - it’s been called a “postal code lottery” where your address determines how lucky you’ll be in accessing help.

“I was just shocked that Toronto has different rules than Vaughan, which has different rules than Scarborough. Every single place is different and I thought the medical system is supposed to be one for all.”

She doesn’t understand why Scarborough is grouped as part of Central East - which includes Haliburton and Peterborough - and not the Toronto region.

“I guess the message is not to buy a house in Scarborough. People don’t know. We have an aging population and people want to stay in their homes for as long as possible and they’re not going to be able to here.”

Her husband is taking a leave from work but he can’t take the place of a personal support worker, she says.

“I don’t know how he’s going to cope.”

For Pisani, being reduced to 21 hours a week would mean she’d have to choose between having a PSW three hours a day and no overnight assistance, or three overnights with no daytime help. Hiring someone to help during the night will cost her over $1225 a week and she’s on disability.

It’s shameful that this proud woman has been reduced to begging for assistance in her dying days.

“I need somebody to wash me and feed me,” she explains. “In the middle of the night, I’m just afraid I’ll try to get out bed and if I fall, that will be the end of me.”

So she’s left with a ridiculous choice: “If I stay at my sister’s house, overnight care is included. If I go home, it is not. Why should I have to move back to my sister’s?” she demands.

“I want to be home, I want to be here for my kids. It’s just not fair.”

Read Mandel Wednesday through Saturday.