End of Life Care With People Experiencing Homelessness

End of Life Care With People Experiencing Homelessness Abe Oudshoorn, RN, Ph. D Assistant Professor, School of Nursing, Western University

Where are the homeless? 2

Who are the Homeless? • 66% mental health challenges • 33% addictions • But, causes of homelessness are as many as the number of people experiencing homelessness 3

How many are homeless? 4

Why are they Homeless? 5

How is their health? 6

CAS What health care do they access? Health Zone LHSC Emergency RMHC St Joseph’s Urgent Care Infectious Disease Care CMHA – Access Team Dale Brain Injury Service John Gordon Home London Crisis Pregnancy Centre Regional Support Associates CCAC SOAHC Pharmacies Wotch LIHC Quinton Warner Addiction Services of Thames Valley Youth Action Centre London Public Library Regional HIV/AIDS Connection Middlesex London Health Unit At’ Lhosa Methadone Clinics My sister’s Place Salvation Army. Mobilizing Hope St Leonard’s EMS Men’s Mission Street Scape Centre of Hope Withdrawal Management Chiropractors@COH Centre of Hope Family Health Team Women’s DOCS – Bethesda Centre Community House Dental Outreach LHSC Women’s Health EMDC

Is their health care appropriate? • ED • Walk-in clinic • CHC • Home care? 8

What is this costing us? 9

Behavioural Barriers? • Or policy barriers? 10

What constitutes ‘palliative’? • “life-threatening illness”, “serious illness” 11

Pain and addiction 12

Treatment solutions • People, most often, will die how they lived. • Harm reduction • Mental health support • Behavioural considerations 13

Structural Solutions • Medical respite – Shelter based? – Hospital based? – Hospice based? – Stand alone? – CHC based? 14

Functional Example 15

Questions 16