September 30, 2020
Hana Irving, MA & Fr. Dr. Matthew Durham, DMin
What defines the experience of aging in Canada? Geography, socio-economic status, physical and mental health all factor into how Canadians live and age in their homes and communities. More recently, the COVID-19 pandemic has also influenced aging experiences, particularly for people with complex health needs. Although the average Canadian has experienced challenges, the homeless population has only recently been spotlighted as a group more significantly impacted by the pandemic and lack of everyday resources necessary to live, age and thrive. This blog will explore how SE Health and the Saint Elizabeth Foundation have been working to create change for the Canadians who are most in need.
COVID-19, Aging and Vulnerable Populations
While discussion of how to create a system that supports Canadians who wish to live and age at home has been at the forefront of health care agendas for decades, it’s only become more necessary during the pandemic. Debate about viral spread, social and physical distancing, the importance of wearing a mask, washing hands, and disinfecting surfaces to prevent infection have become part of everyday life. At the same time, as a society, we’re becoming more aware of the social and economic disparities that have put certain vulnerable populations at greater risk.
Aging While Homeless
Ubiquitous and yet largely ignored in every major city, there are thousands of Canadians who are homeless and lack access to adequate resources to follow public health guidelines about social distancing and hygiene (Jadidzadeh & Kneebone, 2020). These Canadians are often at greater risk for any virus transmission due to crowded living conditions in temporary housing or shelters, congregate settings and an overall 5-10 times greater mortality risk than the general population (Tsai & Wilson, 2020). These risks only increase for people with compromised immune systems or those who may be approaching end-of-life.
For persons experiencing homelessness, access to palliative care has traditionally been a challenge, which has only been exacerbated by the pandemic. Hudson, Shulman and Stone (2017) note that the delivery of high-quality care in mainstream settings for homeless people is complex for many reasons, including mistrust of health services, isolation, the impact and chaos associated with substance or alcohol misuse and, for some, alcohol-related early cognitive impairment. These factors, alongside the relatively young age at which homeless people may benefit from palliative care, means access to hospice and care homes is currently rare. As a result, homeless people often receive inadequate care and support. (p. 54)
For many persons who have experienced homelessness, the overwhelming shame and fear associated with appearing “needy and dependent” prevents both men and women from asking for help. This is compounded by our generally negative view of dependence and aging as a society. A recent study in Montreal found that individuals aged 50-64 were the largest growing demographic of the homeless population as ageism often made it difficult to find new employment and age prevented them from accessing social services and support programs designed for older Canadians (Burns, Sussman and Bourgeois-Guérin, 2018).
Journey Home Hospice: A Saint Elizabeth Hospice Project
SE Health and the Saint Elizabeth Foundation have been investing into end-of-life care for Canadians most in need for more than five years. Practically this has been realized through donations to jumpstart innovative hospice and palliative care projects nationwide and developing expertise as a leader in the end-of-life sector. Through our work, the particular needs of the homeless and vulnerably housed populations became evident. We have supported street-based palliative care programs such as the Palliative Outreach Resource Team (PORT) in Victoria, BC and the Calgary Allied Mobile Palliative Program (CAMPP) in Calgary, AB. More recently, we’ve decided to take a more active role as the operating partner in Journey Home Hospice.
Founded a little more than two years ago through an alliance agreement between Saint Elizabeth Foundation, Inner City Health Associates (ICHA) and Hospice Toronto, Journey Home Hospice is Toronto’s only hospice serving homeless and vulnerably housed individuals. Hosted by Homes First Society in the heart of downtown, the hospice provides 24/7 hospice palliative care including complementary therapies to patients at the end of their lives, with a typical admission having a prognosis of approximately three months. More than pain and symptom management, Journey Home Hospice also offers formerly homeless patients the opportunity to experience “home”, sometimes for the first time in decades. This is especially important during the pandemic when access to supportive services and housing is severely stressed.
The small clinical staff, complemented by specially trained volunteers, often become a “found” family for patients who are typically estranged from their loved ones. Volunteers especially fill an important role: reading stories aloud, singing favourite songs, cooking memorable dishes, playing cards, or even watching movies with patients.
Equally important, Journey Home Hospice becomes a place of healing, even as patients approach end-of-life. Regular meals; a clean, safe place to stay; coordinated pain and symptom management; as well as complementary therapy programs such as art and music therapy, legacy work and a visiting dog program all help patients to reconnect with their humanity after years of hardship and struggle. The psychosocial and spiritual care program also helps patients to reconnect with loved ones if they wish and provides a welcoming space to express their faith or find a connection with their chosen religion.
Future Forward: Shifting Definitions of Dependence
Every patient who has stayed at Journey Home Hospice comes with a story. As each patient begins to feel at home, they will often share their story with a trusted team member or volunteer, and each life history comes with its own unique heartache. Whether fleeing an abusive family or relationship, struggling to cope with mental health issues and addiction, or facing financial setbacks from a divorce or workplace accident, our patients never intended to be homeless. However, once they found themselves without a permanent address, the struggle to find or maintain employment, save enough money for deposits on a new apartment or even access social services became almost insurmountable challenges for many.
Journey Home Hospice becomes even more important in this context as a beacon of hope for patients and as a potential teaching and learning facility on a local, national and international scale. Both from listening to our patients’ experiences and leading research into the factors affecting homelessness, we know that it is largely structural issues that cause and perpetuate homelessness. We are socially conditioned with capitalist values that emphasize individual responsibility, work ethic, and suggest that the only factor that determines success or failure is an individual’s motivation to work towards a goal. In reality, there are political and social factors that shape individual’s access to opportunities, education, resources and the necessary support and social services. Poverty and homelessness are closely tied factors that are caused by an inequitable distribution of wealth and opportunity (Murphy and Eghaneyan, 2018).
Our hospice is creating a truly safe space for people who have experienced homelessness with a specially trained team who is able to respond to their unique life story, physical, psychosocial and spiritual needs, as well as offer care in a flexible environment that is responsive to the needs of the individual. COVID-19 has demonstrated more than ever that health care solutions in Canada must be innovative and responsive; we are proud that in the midst of this pandemic, not only have we been able to offer patients a safe respite at the end-of-their lives, we are also expanding to serve more people in the future.
Currently, Journey Home Hospice is renovating our existing site to add six more hospice beds and hopes to be open in late 2020. For more information about Journey Home Hospice or to support our expansion campaign, please visit: www.journeyhomehospice.ca
Burns, V.F., Sussman, T & Bourgeois-Guérin (2018). Later-life homelessness as disenfranchised grief. Canadian Journal on Aging, 37(2), 171-184.
Hudson, B., Shulman, C. & Stone, P. (2017). ‘Nowhere else will take him’ – Palliative care and homelessness. European Journal of Palliative Care (24)2. 54.
Jadidzadeh, A. & Kneebone, R. (August 2020). Homeless shelter flows in Calgary and the potential impact of COVID-19. Canadian Public Policy. S160-S165.
Murphy, E.R. & Eghaneyan, B.H. (2017). Understanding the phenomenon of older adult homelessness in North America: a qualitative interpretive meta-synthesis. British Journal of Social Work, 48, 2361-2380.
Tsai, J. & Wilson, M. (April 2020). COVID-19: a potential public health problem for homeless populations. www.thelancet.com/publichealth (Vol 5). e186-e187.