Many of us have a hard time imagining that major cities in Canada, including Ottawa, have many homeless or vulnerably housed people in need of essential services. It is also hard to fathom that the homeless population is growing every year, and there are more and more vulnerable people for whom the closest thing to a caring and a stable “home” is a shelter. What happens to this fragile population when they are at the end of life?
According to Lynn Landis, Director of Health Services for the Ottawa Mission, homeless people need services tailored to their specific needs. Homeless people often suffer from complex and chronic comorbidities, have high rates of morbidity and die at a younger age than the general population. Due to a combination of problems at the end of life (e.g., physical, psychosocial, addiction, trauma-related), the homeless population often don’t fit in a traditional care setting.
The multidisciplinary palliative care model at the Ottawa Mission involves “a circle of care” which provides medical and psychosocial support tailored to the needs of homeless people. It is the act of understanding and meeting these specific needs that translates into providing dignity to the most vulnerable members of society.
Palliative care within a shelter setting was and is still considered a pioneer initiative, and the model at the Ottawa Mission is considered a source of inspiration for other shelters. Until 2018, the Ottawa Mission was the only shelter in Canada to offer palliative care.
“Our population has lived a life of struggles with mental health and addiction and they require a different of type of care. They need someone who understands them to be able to offer them the dignity and respect that they deserve, especially at the end of their lives. Our clients have often lived in difficulty with their families, either are estranged or have families that are dysfunctional. So we often play a role of being their circle of family when they are dying. When I talk about dignity, I mean that we offer more than medical care. We offer a circle that is nurturing, we involve volunteers, so they can spend on one on time chatting and being present so that our people are not alone.”
The Mission has been providing comprehensive support (e.g., shelter, food, medical care, employment support) to homeless men and women for more than 40 years. However the Mission’s palliative care program was born in 2001 when a number of the people in shelter suffered from AIDS. After a particularly harrowing case where one of their regular clients ended up dying in hospital even though this was not what he, the hospital staff, or the Mission wanted. It was this system failure that motivated the then Director, Diane Morrison, to work collaboratively with a new Mission partner (Ottawa Inner City Health), and establish palliative care services.
“At the time in the AIDs crisis, many clients in the shelter were very ill from AIDS. One of our typical shelter clients was hospitalized at the end of life. He was exhibiting behaviors that were difficult to manage, such as smoking in his hospital bed, pulling out his iv, and swearing at the care staff. He was challenging and the nurses were having a difficult time taking care of him. He did not want to be there. He tried running away but ended up going back, due to his illness. Our Executive Director, Diane Morrison, bought a hospital bed and put it in the chapel and our team cared for him. But when faced with more complex and a declining health, he was transferred back to hospital. He died in hospital, 2 weeks later. Diane said, ‘this will never happen again’. The Mission partnered with Ottawa Inner City Health, which was created around the same time to provide medical care to homeless and vulnerable community members, and we started the hospice together.”
The Ottawa Mission hospice started with 4 beds in 2001 and has now grown to a 3-floor unit with 7 beds on each floor. Each floor is dedicated to a certain level of care from chronic palliative care where clients have some degree of autonomy and mobility to very end-of-life care where close monitoring is required.
On a daily basis there is one registered nurse as well as 3 client care workers who are trained in mental health and addiction so they are able to support both the nurses and the clients effectively. Volunteers also play a crucial role in many aspects of the hospice, including psychosocial support.
In addition to palliative care services, the Ottawa Mission holds a memorial service for every one of their clients who has died. This service is for family and friends as well as the staff at the Mission.
“This population, our clients, have often been through so much trauma and difficulty, throughout their lives. When arriving to the end of their journey, it could be the most painful and lonely period. But the work we do is to offer our clients a period of time that is filled with care, non-judgement, and dignity. Believing in our vision, to take care of the most vulnerable, is very important to us. And, seeing the commitment from our partners, how everyone comes together to provide such excellent service, a circle of care, is one I would love to see replicated everywhere for the people that have had the most challenging lives.”