Waipuna Hospice is straining under the weight of Tauranga's rapidly growing and ageing population.
Chief executive Richard Thurlow said the palliative care service had a government funding contract for 558 referrals last financial year.
"We hit that on April 21 with May and June still to go."
The service accepted 720 new referrals that year, on top of the 250-300 it was already caring for when the year began - totalling about 1000 patients.
"That's the highest we have ever had. We're getting on for a 10 per cent increase in a single year."
He said this financial year the service will have to raise 45 per cent of its operating costs - about $2.7 million.
"It's really difficult to talk about donations because it's humbling but really we have to ask."
Last financial year the charity had to raise $2.5m. In early 2017, things were looking dire and it faced a second year of deficit.
An application for extra funding was approved by the Bay of Plenty District Health Board and $400,000 from the Waipuna Foundation (a separate charity set up to manage bequests and long-term funding) late in the year got the hospice over the line and allowed it to start this year with a surplus.
Mr Thurlow said the government's funding model used population data from two years ago. The Bay's health budget increased 2.5 per cent, while population growth was closer to 11 per cent, he said.
"Without change, we will find it hard to keep doing what we do."
It was not just the increasing numbers of people stretching the system, it was where they lived.
Mr Thurlow said the expansion of the city - Papamoa East, for example - meant nurses were spending more time on the road just getting to patients' homes.
"It's putting a big strain on us."
The Hospice was considering a satellite site closer to Papamoa to cut down on the commuting hours.
Other pressures included traditional family support units being more spread out around the world, and people living longer with chronic diseases that used to be quicker killers.
He said research conducted by Hospice New Zealand, the Ministry of Health and researcher Heather McLeod projected close to a 50 per cent increase in the number of deaths in New Zealand over the next 22 years.
"The rate of growth is huge. We are on that inflection point now as the baby boomer population is coming through. It's going to grow before it gets smaller."
The hospice had been working to make its services more efficient, including the introduction of a new team tasked with improving how patients moved between different care services, including their GP and the hospice.
"But there's only so many things you can pare back and pare back without losing the ethos of the service. We're at that point where things are getting really difficult."
Waipuna Foundation board chairman Bruce Cameron said the demands placed on the hospice were significant.
The community needed to get behind the service if they wanted to keep the current level of service. "Standing still is going backwards."
"It would be a sad day if Waipuna Hospice's services were not available to all sectors of the community."