Ontario to open end-of-life care facility for Toronto's vulnerable and homeless

Theglobeandmail.com
Dec. 18, 2017
By Rachel Levy-Mclaughlin

The Ontario government is opening a new hospice to provide end-of-life care for Toronto's homeless and vulnerably housed.

Health and Long-term Care Minister Eric Hoskins said that the government will be funding a 10-bed palliative-care facility for the homeless, precariously housed and those living in shelters in Toronto. The first four beds of the Journey Home Hospice will be at the Homes First centre, a non-profit organization dedicated to providing houses to the homeless, with another six beds to be added over two years.

"Ninety per cent of Canadians want to die at home, but what if you don't have a home and can't access traditional home palliative-care supports?" said Dr. Naheed Dosani, a palliative-care physician for the homeless with Inner City Health Associates, one of the partners in the endeavour.

The average life expectancy for the homeless is between 44 and 47, about half that of the rest of the population, according to Dr. Dosani. He added that they are 28 times more likely to have hepatitis C, four times more likely to have cancer and five times more likely to have heart disease.

"Saying that there is a great need [for the hospice] is an understatement," he said.

Homeless patients often don't have access to the support systems, either emotional or monetary, that help to ease the pain and suffering of terminal illnesses.

The Journey Home Hospice would give 40 to 50 patients end-of-life and palliative care every year, depending on the patients and their conditions. The initial phase of the hospice, four beds at Homes First, will be opening after renovation. The remaining six beds will be added to another space, which has yet to be determined, said Homes First CEO Patricia Mueller.

"We've wanted to find a way to support people to live and die at home for many, many years," she said.

The hospice project is a partnership of the Saint Elizabeth Foundation, Hospice Toronto and Inner City Health Associates, each with its own specialization.

"We're able to optimize our knowledge and resources and build a model for what really is a diverse population," said Dena Maule, CEO of Hospice Toronto.

This population, Dr. Dosani said, often feels "alienated" from mainstream health care, feeling stigmatized or discriminated against over substance use or mental health-issues. Many refuse to seek health care because of their previous experiences, so they may not receive treatment or medication for illnesses.

"They're dying cold and alone on the street," said Ms. Mueller. "The last thing we want to see is people dying on the street."

Dr. Dosani has seen first-hand the effects of inaccessible palliative care. During his residency at the University of Toronto, he was working with a terminally ill cancer patient named Terry. He had been homeless more than 15 years, had mental-health and substance-use problems, and he had cancer. Dr. Dosani said Terry tried to receive medication from hospitals, doctors and clinics to ease his pain but was refused time and time again.

Dr. Dosani went in one day to the shelter where he had been seeing Terry and found out that he had died of an overdose.

"For me, this was a really traumatic event that really changed my perception of what's happening on the streets," said Dr. Dosani, who went on to start PEACH, a palliative-care and education outreach program for the homeless and vulnerably housed.

For him, the Journey Home Hospice is the "next level" of his program.

"The program is meant to help people homeless or marginally housed find a place to be supported in their decline," said Ms. Mueller, "to be able to receive this support and dignity that they so deserve and need."