Whom do you turn to when you have a life-limiting illness and live on the streets?
Toronto has come up with one answer, a mobile palliative care team of three palliative physicians and a nurse coordinator providing specialist EOL care to people who are homeless or in precarious housing.
The City of Toronto estimates 91 deaths among people experiencing homelessness in 2019, due to a variety of reasons, including drug overdoses, heart disease and suicide. Operating within the Inner City Health Associates (ICHA) program for people experiencing or at risk of homelessness, Palliative Education and Care for the Homeless (PEACH) provides specialist care to those who are terminally ill.
PCV staff member Nora Fernandes, spent a day shadowing two of the PEACH mobile medical team members in Toronto: Dr. Naheed Dosani, (pictured above with Nora, PCV) the lead palliative care physician, and Sasha Hill, Nurse Coordinator.
At present, Sasha has 85 patients registered with PEACH. She receives referrals from health services around Toronto City, organizes appointments with the palliative physician, follows-up medical tests, access to medication, shelter options, links to other services, arranges practical support, etc. Three days a week, a palliative physican visits patients along with the Nurse Coordinator.
Continuity of care a critical part of the program
PEACH’s focus is on managing pain, symptoms and psychosocial goals. Continuity of care is a critical part of the program for this transient group. “It’s okay, we’ll follow you wherever you are (re)located”, Naheed reassures a patient with cancer, who is about to be discharged from a respite program at a local health service. Or to another, with organ disease but refusing treatment which would interfere with a substance use habit, “That’s okay. We’re here if you need us”.
Remember, reflect, recover and reinvest
Another innovative practice introduced by this team is Healing Circle, a group debrief for all who aided in the care of a PEACH patient who dies. Naheed describes the 4R framework they use: Remember, Reflect, Recover and plan to Reinvest. The goal is to enable those involved in the caring process to deal with their grief and distress and to reinvest in working with this marginalized community.
Last year, Journey Home Hospice, an end-of-life centre for people who are homeless, opened in Toronto. Other cities in Canada and UK have followed suit, replicating this program for marginalized populations experiencing housing vulnerability at end of life.
For further information, email PEACH Nurse Coordinator, Sasha Hill: HillSa@smh.ca