Meeting the end-of-life needs of the homeless & vulnerably housed: Taking palliative care to where patients are
There is alarming data and information coming out of our homeless shelter systems.
- Average life expectancies for homeless persons are estimated to be between 34 and 47 years
- Mortality rates among homeless populations are 2.3-4 times higher than the general population
- Despite exhibiting signs and symptoms of extensive disease, homeless individuals often do not receive end-of-life care because of their immediate environment
- Many healthcare and social service providers feel that mainstream Palliative Care services are generally inaccessible to homeless populations
- Despite a keen interest in Advanced Care Planning (ACP) and specific preferences for location of death, 34-59% of the time, homeless patients die in acute-care hospital settings
Through the launch of a new pilot program starting this July, I’ll be heading out into the community with a team of healthcare professionals to provide Palliative Care to patients who are homeless and vulnerably housed. Our new program, entitled “PEACH” (Palliative Education And Care for the Homeless), is an initiative of the Inner City Health Associates (ICHA). ICHA is a group of more than 60 physicians working in shelters and drop-in sites to provide care to homeless and marginally housed individuals in the Greater Toronto Area (GTA). The PEACH initiative aims to bring interdisciplinary Palliative Care to these patients who represent one of our most vulnerable and marginalized populations, by meeting patients wherever they may be. By this, we mean two things:
- Geographically. Traditionally in palliative care, we’ve required patients to visit us in clinics, receive us in their homes, or be in a hospital or hospice bed for us to provide appropriate end-of-life care. Unfortunately, for vulnerable populations such as patients who are homeless or suffering from a mental illness, this doesn’t always work. Our mobile, shelter-based program will be going into the community to meet patients with serious illnesses, wherever they are located. By providing increased community resources and supports to our partners within the shelter system, we hope to meet the end-of-life wishes and preferences of our patients so that they may receive the care they need with respect and dignity.
- Medically. For a variety of reasons, the early identification of Palliative Care needs among vulnerable populations is relatively uncommon. There is increasing evidence that the provision of early Palliative Care, even as soon as someone is diagnosed with a terminal illness, should be a priority for all. Through PEACH, we aim to meet the needs of patients wherever they may be, along the trajectory of their disease process. As part of this, we hope to provide early and upstream Palliative Care integration to ensure access for all patients, not just for those who have been admitted to a hospital. This will allow us to better manage pain and symptoms, provide psychosocial supports and appropriately meet the goals of care, of such patients. To our knowledge, PEACH will be the first service to apply early Palliative Care to a vulnerable patient population.
We are also interested in education around Palliative Care and homelessness – being a resource to healthcare providers who may care for homeless & vulnerably housed patients. Through this pilot program, we hope to gain insight into some of the unique challenges of providing Palliative Care services to homeless and vulnerably housed individuals and further develop best practices for how to better address their needs.
A community-based outreach program such as PEACH requires dedication, commitment and strong supports from the Palliative Care community in the GTA: We are thrilled to be collaboratively partnering with the Toronto Central CCAC, Toronto Grace Health Centre, Mount Sinai Hospital’s Temmy Latner Center for Palliative Care and St. Michael’s Hospital’s Palliative Care Unit.
Reprinted with permission from St. Michael's Inner City Health blog.
Naheed Dosani is a Palliative Care & Family Physician at William Osler Health System & the Inner City Health Associates (ICHA). He recently completed his fellowship in Palliative Medicine at the University of Toronto and prior to that, his Residency in inner-city Family Medicine, where he served as Co-Chief Resident of St. Michael’s Hospital Family Medicine Residency Program. He is a researcher, with projects underway investigating the impact of housing on health, social media as a tool for communication among healthcare providers and palliative care for heart failure patients. He teaches medical students & residents, serves on the Board of Directors for the Agincourt Community Services Association and is the staff advisor for Students for Medicare. Dr. Dosani is passionate about the social determinants of health, inner city health, global health equity and social media. You can follow Naheed on Twitter @NaheedD
-Important work being done for a most marginalized sector of the population. As a retired RPN who worked in palliative care for 15 years, I had no idea about the research & programs that have been initiated along with the support and collaboration of so many partners. It has always perplexed me that in such a rich country as ours, why Canada has so many homeless people. More needs to be done about this growing problem. Thank you to all the hard work and commitment of so many- around this issue. I've read quite a bit about Dr. Gary Bloch's work and it is all very impressive.I am considering some volunteerism in this area in a non-nursing capacity.
This is a wonderful project, so many of my homeless clients have not received any end of life care. Sadly I think it is because of stigma and how they are treated at hospitals and the general population. It always seems to takes a lot of convincing to get them to get clients in for general medical care. This will make things so much better for those with terminal illnesses, they can be treated where they are most comfortable, like any other human would be. Fantastic!
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