Promising Practices for Improving Equity in Access to Palliative Care
Many current models of palliative care are not prepared to meet the needs of people who are vulnerably housed, staying in shelters or living in outdoor spaces. The healthcare system can make inequities worse as people who are already structurally vulnerable can experience stigma, discrimination and racism when accessing care. There are often barriers to diagnosis, treatment and support needs, which means that health conditions that could be preventable or treatable may become life threatening.
In response, communities across Canada have designed innovative models of equity-oriented palliative care to improve access to safe and high-quality palliative care for those experiencing structural vulnerabilities. These models ensure care is delivered in a timely way, help reduce emergency department visits and hospital admissions and allow people to receive care with dignity in their environment of their choice.
The promising practice summaries were created to profile leading innovative equity-oriented palliative care models from across the country. These summaries offer details about:
- how the promising practice works
- partnerships and collaborations
- evaluation and impacts
- lessons learned, including enablers and challenges
Promising practice summaries
Diane Morrison Hospice (Ottawa, ON)
The Diane Morrison Hospice is a 21-bed hospice offering palliative and end-of-life care for people experiencing homelessness. Their model of care provides 24-hour/day palliative nursing care, emotional, cultural and spiritual support and dignity.
George’s House (Edmonton, AB)
George's House offers a secure, communal-living environment in a quiet neighborhood for those nearing end of life and facing the risk of houselessness. With capacity to assist up to five clients, residents receive 24-hour care in a home-like setting, complemented by in-reach clinical support, and dedicated services from George Spady staff and Alberta Health Services Palliative Care specialists.
Kensington Hospice (Toronto, ON)
Kensington Hospice is a 19-bed in-patient hospice. It is part of Kensington Health, a community organization that includes long-term care, hospice care, community care and ambulatory care services. The Hospice’s day-to-day operations are built upon a health equity and health justice approach; this is a model of care called “Radical Love.”
Maison du Père (Montreal, QC)
Maison du Père is a shelter for men experiencing homelessness. In addition to its emergency shelter, it has a 10-bed convalescent unit that includes two beds for palliative care and two for end-of-life care. A key objective is to reintegrate people into housing, including Maison du Père’s long-term care residence, while continuing to provide palliative care to these clients.
Medavie Community Paramedicine (Improving Equity in Access to Palliative Care – Wellness Clinics) (Saskatoon, SK)
Medavie delivers a palliative approach to clients within the community, where the clients direct their own care. It offers Wellness Clinics in spaces where clients already are, such as the John Howard Society. These Wellness Clinics with community paramedics take place three times a week and can involve anything from checking vital signs, assessing a wound and connecting the client to other healthcare and community care services.
Palliative Care Outreach and Advocacy Team (PCOAT) (Edmonton, AB)
PCOAT provides services to socially vulnerable people, providing patient-centred and equitable palliative care. The team builds relationships to develop and implement a delivery model for palliative care that is primarily informed by community members.
Palliative Education and Care for the Homeless (PEACH) (Toronto, ON)
PEACH is Canada’s first mobile palliative care intervention for people experiencing homelessness. The program provides home care supports, manages pain and symptoms and supports community partners in health and social services through education.
Palliative Outreach Resource Team (PORT) (Victoria, BC)
PORT is a mobile service for people who have progressive life-limiting conditions and who have challenges accessing palliative support as a result of homelessness, poverty, racialization, stigma, discrimination and lack of social support. Staff meet clients where they are, working alongside their friends, family and service providers to ensure that the client has support if they are facing advanced, progressive illness and are nearing end of life.
Six Nations (Ontario)
This program began in 1999 in the Six Nations community with a focus on palliative populations. The team includes clinical nursing services, a case manager/care coordinator for palliative care, a project manager and personal support workers who connect with a registered nurse virtually using a telemedicine model.
Thunder Bay Palliative Advocacy & Care Team (PACT) (Thunder Bay, ON)
PACT provides primary healthcare and social services with a focus on advocacy and education. The team provides education to palliative care providers on how to better provide service to clients who are vulnerably housed, to front-line social service providers on the benefits of a palliative approach to care and to clients on their rights.
Why this work matters
The health outcomes of people experiencing homelessness are in stark contrast to the general population, with substantially greater risk of disease, morbidity and mortality. The Federal Action Plan on Palliative Care highlights the importance of taking action to improve access to palliative care for underserved populations, including improving access to culturally safe and appropriate care. Equity-oriented care recognizes system barriers and seeks to address them to ensure access to high-quality care.
"These promising practices demonstrate the impact of designing and delivering compassionate, person-centred, trauma-informed care while incorporating principles of harm reduction, anti-oppressive practice, interprofessional approaches and culturally safe(r) care."
"By working in new and innovative ways we can improve care, together."
"People who experience homelessness and other structural vulnerabilities often lack equitable access to palliative care."
Dr. Kelli Stajduhar
Professor and Canada Research Chair (Tier 1), Palliative Approaches to Care in Aging and Community Health, University of Victoria
Dr. Naheed Dosani
Palliative Care Physician, Department of Family & Community Medicine, St Michael's Hospital at Unity Health Toronto