Palliative Education And Care for the Homeless (PEACH): A

Palliative Education And Care for the
Homeless (PEACH):
A Palliative Care intervention for
marginalized & vulnerably housed
populations in Toronto
Naheed Dosani MD, CCFP
A social justice issue...
The narrative
A social justice issue...
The data
A Snapshot: Toronto’s Homeless
● homeless: 5200
o in streets: 450
1+ chronic disease: 75%
HCV: 28x | Heart Disease: 5x | Cancer: 4x
severe depression: 30%
elderly: 10%
Street Health Report, 2007
Street Needs Assessment, City of Toronto, 2013
Early Onset Illness and Mortality Group, 2011
Health and Housing in Transition Study, 2010
A Snapshot: Toronto’s Homeless
Vulnerably Housed:
● >50% income = rent
monthly income [after rent] = $470
● Housing:
poor conditions
instability, recent or episodic homelessness
comorbidity prevalence comparable to homeless
Hwang, 2010
Health and Housing in Transition Study, 2010
Homelessness at EOL
Life expectancy: 34-47 yo
Mortality rates: 2.3-4x
2020: 58 000 new seniors/yr [US data]
Location of death:
transitional spaces
residential dwellings
in-hospital [34-59%]
Podymow et al, 2006
Hwang et al, 2009
Cagle, 2009
How it all started...
● Mobile
● Shelter-based service
● Early Palliative Care
Our goals...
1. Provide high quality early, integrated palliative care
2. Support and be a resource to ICHA’s primary care
providers in the provision of EOL care
3. Provide support to mainstream Palliative Care
services in the provision of EOL care
Our goals...
4. Increase confidence among community homeless
agencies to support clients facing EOL
5. Advocate for accessible, high-quality, early and
integrated Palliative Care
6. Advance the body of knowledge for the delivery of
Palliative Care for homeless & vulnerably housed
● Launch in July 2014
o Media exposure
● Collaborative partnerships:
o TC CCAC, SMH, TLCPC, Toronto Grace,
Kensington Hospice & more to come!
o Hospice Toronto, Anishnawbe Health, Church
of Saint Stephen-in-the-Fields & more!
● Care provision:
o 25+ patients
o Models of care
o Early vs late
o Malignant vs non-malignant
o M vs F
o Geography
o Outcomes
● Advocacy:
o Academia
o Service agencies
o Blog posts, social media, commentaries
o Bill M-456 - Pan-Canadian Palliative/EOL Strategy
● Research

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