According to data collected by the six Island boards of health, there were 92 deaths on Martha’s Vineyard in 2013. One year later, there were 130. Five years later, there were 189.

By 2030, the annual number is projected to be as high as 370.

“When I got hired, I said stop the presses,” said Thomas Hallahan, who serves as executive director of Hospice of Martha’s Vineyard, the Island’s unique, no-cost hospice care provider. “We are an aging population . . . As the numbers increase, we will increase.”

Unlike almost every other hospice provider in the country, Hospice of Martha’s Vineyard is free and does not take private payments or insurance, allowing them immense flexibility about who they service and the care they can offer. The unique model means that no qualified end-of-life patients are turned away.

It also means that as the Island grays, and a significant baby boomer population approaches the later stages of life, the hospice census will have to grow as well. And that in turn will mean unique logistical challenges, increased financial need, altered demographics and new beginnings for an organization that has spent the last 40 years — and plans to spend over 40 more — focused on endings.

That’s why one of Mr. Hallahan’s first steps as executive director was to collect data on the Island’s aging population — data that was previously unknown.

“I had no records,” Mr. Hallahan said. “You track school enrollment by births . . . So I said, well let’s do deaths. Now we call the boards of health every January. They expect it.”

Upon analyzing the numbers, Mr. Hallahan and his staff saw that the number of deaths on the Island were steadily increasing. With the help of an intern from Dartmouth College this summer, they did a regression model to show what those numbers would look down the road, revealing that the number of people who need services could double in just over 10 years. The model has an 85 to 87 per cent predictability, Mr. Hallahan said.

“We are planning staffing. We are planning space,” he said. “You can’t sit back and say we’ve done our data analysis, this is the way it’s going to be. Each year, you’ve got to recalibrate and say, this is the way it’s going and are we on track? Because we are in a unique environment.”

Nationwide, between 30 to 40 per cent of the dying population receives some type of hospice care. But Martha’s Vineyard, as well as much of coastal Massachusetts, has a disproportionately large population over the age of 65, meaning that it has a higher percentage of people dying, and thus a higher percentage requiring services near the end of their lives.

“They call it Medicare-by-the-Sea,” Mr. Hallahan joked lightly.

According to data from the Martha’s Vineyard Commission, the state has a median age of 39.5. Because of the large elderly population on the Island, the median age in Dukes county is six years older. By 2030, the commission projects the Island will have twice as many residents over the age of 65 and twice the number of residents over 85, changing from about 3,000 to 6,000, and 391 to 607 respectively.

When Hospice of Martha’s Vineyard began, the organization’s clinicians were generally servicing around 10 patients per month. By the time Mr. Hallahan took over, that number was around 17 or 18. Now, over the past 18 months, they have generally had between 30 and 40 patients every month.

Clinical director Chantale Patterson has felt the increase in patients acutely.

“You can look at it from a staffing perspective,” she said. “We’re going to need more nurses because we are going to have more patients.”

Although the spike in census numbers doesn’t come as a surprise, it has also forced Mr. Hallahan and his small staff to make difficult decisions about their services, re-evaluating many of their patients who may not have fit the Medicare standard for terminal illness and hospice care. They have also planned for a nearly 30 per cent budget increase for the next year, projecting $1.1 million, compared with $750,000 in 2019.

“Historically, people have asked if their parents who are old and alone can go into hospice,” Mr. Hallahan said. “Before we had the capacity to help. That we are not so free of doing anymore.”

For the first time ever, hospice has a wait list for its one-of-a-kind bereavement services, pushing the limits of the 13 months of cost-free grief counseling that hospice provides.

But the organization has taken steps to respond to the Island’s changing demographics and aging population. Not long ago, there was only one full-time staff member. Now there are three. And there are plans to hire an additional full-time nurse, expand bereavement services, and hire an assistant to help Ms. Patterson.

The organization also hopes to reach many of the Island’s previously under-served communities, including the Portuguese-speaking Brazilian population, as well as pediatrics. One of the nurses hospice has added has Brazilian heritage, and has helped other nurses work with Brazilian caregivers to decrease the cultural stigma around the term hospice, re-translating literature and interfacing with the community about end-of-life-care.

“The word [hospice] itself actually means mental illness in translation,” Ms. Patterson said. “We had no idea.”

She added, sadly, that with the rise in drug-related deaths and suicide, there is an expanded need for bereavement services for children — a demographic with which hospice does not currently work. And while cancer remains the number one illness for patients in hospice, accounting for about three-quarters of their caseload, dementia, Alzheimer’s and other neurological disorders are also on the rise.

The increased need creates a dilemma for an organization that is already short staffed.

“We are sort of tiptoeing into the arena because we don’t want to offer something that resource-wise we can’t do,” Ms. Patterson said. “But at the same time there really is a need for it.”

Recently, the organization hired a part-time development director, Jessica Rogers, who helped raise over $200,000 at the annual fundraiser and plans to help kick off a $10 million capital campaign. With bereavement and clinical services increasing, hospice is looking for a new, expanded space that will help with the difficult issue of maintaining privacy, dignity and confidentiality for their patients — all constants on a small Island.

On Wednesday, Mr. Hallahan’s office overlooking the Lagoon Pond in the Tisbury Marketplace was packed with moving boxes as they planned for a temporary expansion upstairs into the former offices of Sail MV. He stressed that the organization is looking for a new long-term home. Although hospice patients range in age by 70 years, with the youngest in their 30s, they currently have four patients over 100.

It’s one of the most remarkable aspects of the organization. But it’s also a sign of the future.

“We’re all going to die, and we need to have that conversation,” Mr. Hallahan said. “Because talking about death openly, and planning for death, is something we should all be doing. But now, with this aging community, it’s forced us to have this conversation that should have come naturally. By having us in place . . . it makes their journeys smoother.”

The Gazette will donate $15 of every new renewal subscription from now until Jan. 31 to Hospice of Martha’s Vineyard.