Palliative care is composed of services provided to those at the end of their lives, either from old age or serious illnesses. Palliative care services can be provided in hospitals, nursing homes, shelters, hospices, at home and to a certain extent at drop-in centres or on the streets.
The goal of palliative care is to ease the end-of-life transition, reduce pain, provide medical support and prepare the client and family/friends for impending death. Palliative care is often in a 24-hour facility or at home including visiting nurses, doctors and additional supports provided by friends or family members. It is designed to help the terminally ill spend their last days with dignity and less suffering.
Last year, the Homeless Hub had posted a blog article discussing the types of palliative care services available to the homeless population, as well as the barriers in accessing them. In this article, I will list some of the palliative care services in Canada serving the homeless populations.
So what’s available?
Toronto
Currently, there are more than 5,000 people experiencing homelessness in Toronto. A recent research study shows the homeless population is more likely to have a wide range of health issues and have two to four times higher mortality rate than the general population. Dr. Dosani, who previously wrote a blog entry on the need for palliative care that meets the needs of people experiencing homelessness, is a palliative care and family physician at PEACH (Palliative Education and Care for the Homeless) offered by Inner City Health Associates (ICHA). ICHA is currently composed of a group of more than 60 health care providers working in over 40 shelters and drop-ins across the City of Toronto, providing health care to the homeless population. Last year, Dr. Dosani performed a powerful TEDx talk, describing PEACH as a service aiming to build partnership between community agencies and the mainstream health system, to ensure that people experiencing homelessness receive the same healthcare other Canadians receive.
Recently, CBC ran a news segment of what Dr. Dosani’s day looks like as he supports his patients. His work takes him from one end of the city to the other wherever his patients are currently staying. Through his advocacy, Dr. Dosani illustrates the great need for programs like PEACH by telling the story of Terri, one of his former patients experiencing homelessness whose tragic death had a profound impact on his work. This experience pushed Dr. Dosani in his quest to ensure the homeless population is not denied of palliative care they too need. He has also written about PEACH and some of the alarming health data coming out of Toronto’s shelter system such as the average life expectancies for people experiencing homelessness are estimated to be between 24 and 47 years. To put this into perspective, the life expectancy of the general population is 83 years old for women and 79 for men.
The program is not only about providing care services but also increasing the capacity of community homeless agencies to support the end-of-life clients, educating mainstream palliative care services about homeless people, advocating for high quality, early and integrated palliative care, as well as advancing the body of research in this area.
Ottawa
The Ottawa Mission’s Diane Morrison Hospice is a 24-hour palliative nursing care available to people facing their final days. It was founded in 1999 and since then, the Mission has partnered with Ottawa Inner City Health and other health care professionals to support patients at any stage of their illnesses. The hospice has space for up to six people needing round the clock care and nine spaces for those needing chronic palliative and extensive health care services. Three more spaces are available for terminally ill clients living elsewhere in the community.
The hospice program serves men, women and couples and is committed to welcoming anyone experiencing homelessness while needing end-of-life care. The goal is to provide patients with the equivalent of a home and a family, as well as staff who are trained to provide quality care comparable to what is provided to non-homeless Canadians. They have trained volunteers, and their doors are open to family and friends who also provide support. The hospice has access to religious caregivers including Indigenous spiritual support staff.
What differentiates this program from other mainstream palliative care services is their harm reduction approach. Patients are not required to abstain from using substances as long as they are not posing a risk to others at the facility. The program is not only a health care facility; it is a space to strengthen communities and bring meaning and dignity to the end of life of those experiencing homelessness.
Calgary
The Calgary Allied Mobile Palliative Program (CAMPP) is a new two-person team providing care to the homeless population in Calgary suffering from terminal illnesses. CAMPP launched in October 2016 as a mobile service with one nurse coordinator, Rachel Edwards, along with Dr. Simon Colgan. As a new service less than 6 months old, their future is uncertain. CAMPP’s website does not provide information on its program but lists its contact information and a link to their donation page.
In just a few months, CAMPP has served 40 people while making no demands from patients to stop using substances. In an interview with CBC, Dr. Colgan said, “I wanted to make sure that things like addiction and lifestyle didn’t preclude people from the best quality of end of life that we could offer.” The team visits the city’s Drop-In and Rehab Centre, Alpha House and even search for potential patients staying under bridges. It is estimated that approximately 550 homeless people with two or more chronic conditions are currently living in Calgary. With so much need for palliative services among the homeless population, Dr. Colgan recently shared with us that CAMPP recently received funding to extend the program.
Do Mind the Gap
Thanks to the increasing research highlighting the gap of palliative care services available to the homeless population, there has been an increasing recognition of the pressing health care needs in this area. However, there still remains a service gap in Canada.
A recent article on PORT, a network bringing together some palliative services catering to the needs of the homeless population in the Vancouver Island area, stated there is not enough funding. Dr. Kelli Stajduhar and Ashley Mollison of the Institute on Aging and Lifelong Health at the University of Victoria, who co-wrote the article, explain that the lack of funds is typical for hospices across Canada. As a solution, Dr. Dosani provided three cost-effective recommendations:
- Providing accessible health care by getting health care professionals out in communities to treat people early in their disease journey.
- A flexible health care system by adopting approaches such as harm-reduction to build relationships with people who have experienced years of discrimination and trauma should be developed.
- Humanistic and compassionate care that respects human dignity beyond the stigma of patients’ marginalization needs to be promoted.
Palliative care delivery system that meets the health care needs of the homeless populations requires funding for a robust infrastructure. On the other hand, it does not have to be costly, as suggested by Dr. Dosani. Health care services should not be confined to only those who are housed – We should not forget health care is part of the Canadian ethos.
Resources
- Advance care planning, palliative care, and end-of-life care interventions for homeless people: A systematic review
- End-of-Life Care for Homeless Patients: She Says She is There to Help Me in Any Situation
- Shelter-Based Palliative Care for the Homeless Terminally Ill
- Advance care planning, palliative care, and end-of-life care interventions for homeless people: A systematic review
- The Homeless Terminally Ill and Hospice & Palliative Care
- Minding the gap: access to palliative care and the homeless
This post is part of our Friday “Ask the Hub” blog series. Have a homeless-related question you want answered? E-mail us at thehub@edu.yorku.ca and we will provide a research-based answer.