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Palliative home care for the homeless

Toronto, July 29, 2014

By Geoff Koehler

Daniel Thibideau, Harvey Stubbert and Dr. Naheed Dosani
Harvey Stubbert, a nurse from Fred Victor Housing, and Dr. Naheed Dosani, a palliative care physician at St. Michaels, meet with patient Daniel Thibideau during the mobile unit’s first palliative consult. (Photo by Yuri Markarov)

Homeless and under-housed individuals have specific preferences for where they’d like to die and on July 2, Inner City Health Associates – a group affiliated with St. Michael’s Hospital –began making their preferences a reality.

Palliative Education and Care for the Homeless, or PEACH, is a mobile palliative care program that offers vulnerable individuals the dignity of choosing where to receive end-of-life care.

“Most people want to pass away at home with family around them,” said Dr. Naheed Dosani, a palliative care physician with St. Michael’s and Inner City Health Associates. “That sentiment is no different from the patients PEACH aims to treat. The only difference is that our patients’ homes are often a shelter and their families may be shelter clients and staff.”

An interdisciplinary team, comprised of a palliative care physician and nurse, will essentially form a mobile palliative unit. The team will go out into the community to meet patients with serious illnesses to provide specialized care and work with the patient’s existing care team.

“Research has shown that when palliative care begins early, it has the potential to improve quality of life and, in some cases, even prolong life,” said Dr. Dosani. “That seems counterintuitive but reveals the importance of palliative care’s integration with the rest of medical treatment. With PEACH, we want to provide upstream, streamlined integration, for this underserviced population.”

Namarig Ahmed, a community nurse with Inner City Health Associates and the PEACH program coordinator, heads the education arm of PEACH.

Inner City Health Associates works in more than 40 shelters, drop-ins and community sites in Toronto and will use their network to recruit patients who can benefit from PEACH. Ahmed and Dr. Dosani developed additional partnerships with palliative care centres such as St. Michael’s Palliative Care Unit, Toronto Central CCAC, The Toronto Grace Health Centre, Kensington Hospice, and the Temmy Latner Center for Palliative Care, prior to the launch of PEACH.

“Many are surprised that we’re able to offer this care to people who are living in shelters and on the street,” said Ahmed. “But all of the community partners are thrilled to be able to provide this important service to their clients.”

PEACH will have a research component as well, evaluating the needs of this vulnerable population and exploring issues related to palliative care delivery for this unique group.

To learn more about PEACH, please write to peach@smh.ca.

By the numbers:

  • Average life expectancy for Canadian men is 80 years, for women 84, but the average life expectancy for homeless people is between 34 and 47 years
  • Mortality rates among the homeless are 2.3 to four times higher than the general population
  • Despite a keen interest in palliative care and specific preferences for location of death, 34 to 59 per cent of the time homeless patients die in hospitals

Goals of the program:

  1. Clinical: Providing early, integrated and safe palliative care for this patient population
  2. Communication: Improving awareness of the unique issues faced at end of life by homeless and vulnerably housed patients
  3. Collaboration: Improving access to existing, mainstream palliative care services
  4. Advocacy: Advocating for a system that provides access to early, integrated palliative care for these patients
  5. Research: Using evidence-based research to assist in policy-setting and advancing knowledge of the delivery of palliative care for homeless and vulnerably housed patients at end of life

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.