The unique needs of people experiencing homelessness or vulnerable housing are often overlooked in palliative care. With a need to develop inclusive approaches to care, many communities across the country are working towards improving access using a health equity approach.
As one of 23 communities participating in the Improving Equity in Access to Palliative Care (IEAPC) Collaborative being supported by 日本无码 and the Canadian Partnership Against Cancer, the Palliative Advocacy & Care Team (PACT) in Thunder Bay provides primary healthcare and social services with a focus on outreach, advocacy and education.
Palliative Advocacy & Care Team
Originally starting as the Vulnerably Housed Working Group led by Hospice Northwest in 2019, the initiative rebranded as PACT in 2023. PACT brings together a community of health and social care teams in Thunder Bay (ON) in an effort to ensure every community member receives access to the palliative care they need. Essential to this model are bi-weekly rounds focused on individual needs and developing plans to support these needs (e.g. an outreach worker might go to a shelter at the end of day to try to find a client with palliative care needs and support their hospital visit to access needed care). As part of the PACT model, a larger group of leaders also meet bi-monthly to identify longer-term strategies to improve palliative care access in the city and surrounding areas.
These meetings brought to light the challenges people experiencing homelessness or vulnerable housing encounter when it comes to accessing care 鈥� challenges like transportation, finances, uncertainty of resources (such as assistance with housing, access to community support and understanding what the PACT team can offer as an interprofessional team) and large systemic issues such as stigma, racism and discrimination.
Supporting equity-oriented approaches to palliative care
Healthcare systems don鈥檛 always consider the unique experiences and needs of people experiencing homeless or vulnerable housing which sometimes makes the healthcare system an unsafe place for them to receive care. Many of PACT鈥檚 clients shared that they felt a disconnect between themselves and healthcare providers 鈥� feeling discomfort in talking about their healthcare needs or feeling like their providers didn鈥檛 understand their needs.
PACT recognized the need for 鈥溾�� 鈥� people who could act as a two-way conduit between healthcare providers and people experiencing homelessness or vulnerable housing with life-limiting illnesses. As well, PACT saw the need for including people with lived experience who could build trusting relationships with clients.
Enter Julie Diner, a palliative harm reduction support worker at NorWest Community Health Centres, part of PACT.
鈥淭he reason that these folks don't trust you is not because of you, but it's because of the system and it's because of their past experiences,鈥� explains Julie. 鈥淚 was also homeless and pretty sick鈥t's good to have someone with lived experience to be working with folks. They're not going to trust the doctor, but they might trust me or someone like me who's actually been there.鈥�
People who are experiencing homelessness or vulnerable housing are 鈥溾��, so figuring out how to navigate a life-limiting illness is not at the top of their list. Furthermore, the system is often not built to address their specific needs.
Julie鈥檚 position enables her (and PACT) to ensure people鈥檚 palliative care needs are being met by going out into the community, connecting and building relationships with clients, and educating them about available services that can meet their needs. She helps reduce the challenges in access for these clients 鈥� helping them get ID and transportation, advocating for their care needs or simply being with them during their appointments.
鈥淲e need to understand that folks who are homeless鈥they] are humans and people just like you and I,鈥� says Julie. 鈥淭hey deserve to die with dignity. They deserve to die the way they want to. They鈥檝e suffered so much in their lives that they shouldn鈥檛 have to suffer at the end.鈥�
Enhancing cultural safety
According to PACT鈥檚 intake survey of clients in 2024, 54% of respondents identified as First Nations, Inuit or M茅tis. To better serve their community, PACT continues to look for ways to enhance the way they work, cultivating partnerships and educating other healthcare providers on how to provide palliative care through a culturally safer lens.
鈥淲orking with Holly Prince, our IEAPC Collaborative coach, we felt she created a safe space to ask questions [around culturally safer care]. We felt supported in our journey of learning and unlearning and it helped us to identify the need to engage the communities we are serving and the best way to do it,鈥� says Brittany D鈥橝ngelo, formerly the manager of Palliative Carelink at NorWest Community Health Centres. 鈥淔or example, we used to just ask in our intake forms if they identify as First Nations, Inuit or M茅tis. But one of her recommendations was to understand who [the client鈥檚] home community is and which tribal councils to engage and bring into the working group.鈥�
The PACT team acknowledges that they are on a continuous learning journey as they strive to address gaps in providing culturally safer care. By connecting with other teams in the IEAPC Collaborative and attending program workshops (where they learned about the difference between western medicine and First Nations, Inuit, and M茅tis cultural approaches to end-of-life from coaches, Elders and partners), they鈥檝e been able to bring these learnings back to their working group and explore how to improve care.
What鈥檚 next?
"[Julie]'s real, she cares, [is] helpful and does what she says she's going to do for you. When I met Julie, I wanted to die, she saved my life and I'm forever grateful for meeting her," says one of Julie's clients. "Thank you, NorWest Health Centre, for sending Julie Diner my way [鈥揮 she's my angel; she makes me want to ... get healthy."
Through outreach, advocacy and education, PACT is supporting people experiencing homelessness or vulnerable housing to access the palliative care they need and deserve. Through the support of the IEAPC Collaborative, they鈥檙e also gathering additional data (through surveys and intake information) to make sure they鈥檙e meeting the needs of their community as well as make the case about its impact and the need to support this work going forward. Their work has garnered national and international interest as a promising practice in improving access to care.
Looking to get involved or find additional resources on equity-oriented approaches to care?
- Get in touch with the PACT team at info@hospicenorthwest.ca or info@norwestchc.org.听听听
- about the initiative, created by PACT (available in English only).听
- Learn more about the communities participating in the Improving Equity in Access to Palliative Care Collaborative.听
- Discover innovative equity-oriented palliative care models from across the country.听
- Explore culturally safer and equitable care through 日本无码鈥檚鈥�Equity, Diversity and Inclusion Virtual Learning Exchange.听
