Recommendations for Improving the End-Of-Life Care System for Homeless Populations: A Qualitative Study of the Views of Canadian Health and Social Services Professionals

BACKGROUND:Homeless populations have complex and diverse end-of-life care needs. However, they typically die outside of the end-of-life care system. To date, few studies have explored barriers to the end-of-life care system for homeless populations. This qualitative study involving health and social services professionals from across Canada sought to identify barriers to the end-of-life care system for homeless populations and generate recommendations to improve their access to end-of-life care.METHODS:Semi-structured qualitative interviews were conducted with 54 health and social services professionals involved in end-of-life care services delivery to homeless persons in six Canadian cities (Halifax, Hamilton, Ottawa, Thunder Bay, Toronto and Winnipeg). Participants included health administrators, physicians, nurses, social workers, harm reduction specialists, and outreach workers. Interviews were audio-recorded, transcribed verbatim and analysed thematically.RESULTS:Participants identified key barriers to end-of-life care services for homeless persons, including: (1) insufficient availability of end-of-life care services; (2) exclusionary operating procedures; and, (3) poor continuity of care. Participants identified recommendations that they felt had the potential to minimize these barriers, including: (1) adopting low-threshold strategies (e.g. flexible behavioural policies and harm reduction strategies); (2) linking with population-specific health and social care providers (e.g. emergency shelters); and, (3) strengthening population-specific training.CONCLUSIONS:Homeless persons may be underserved by the end-of-life care system as a result of barriers that they face to accessing end-of-life care services. Changes in the rules and regulations that reflect the health needs and circumstances of homeless persons and measures to improve continuity of care have the potential to increase equity in the end-of-life care system for this underserved population

Combining bibliotherapy and community-based intervention: An alternative model for treating depression in older adults with health problems.

Older persons who suffer from health problems leading to functional impairment are at risk for developing depression. Moreover, the combination of functional impairment and depression creates a complex situation requiring special treatment consideration. A successful intervention must address issues unique to late-life depression and must do so in the context of physical disability caused by serious health problems. The purpose of this work was to create a community-based intervention program that would address the needs of this special population of older persons. An intervention based on behavioural principles and on an empirically validated model, Lewinsohn's (1986) Control Your Depression , was modified to suit the needs of this population. The modifications included three distinctive features. First, the program was designed to be readable and relevant to the life circumstances of older adults with special physical impediments. Second, the aim of the program was to deliver this intervention in a self-administered, minimal-contact format, in order to facilitate access to this under-serviced population. Third, the program was adapted to be delivered by non-mental health professionals---in this case, home-care nurses---who were in a health-care delivery role with older individuals. These three elements were combined to create an efficacious model of service delivery that was able to overcome barriers to access, make use of existing community resources, address special issues of functional impairment, and that was deliverable with minimal supervision. This model was tested in three separate series, each with two participants. A multiple-baseline design allowed a data-driven refinement of the model, and was also well-suited for behavioural analysis. In Series A, we tested the feasibility of the model. Results indicated that the program is feasible, and especially highlighted the role of reinstating pleasant activities in alleviating depression in these participants. Series B further examined the role of pleasant activities. Results confirmed the initial findings that reinstating pleasant activities is a pivotal part of the treatment for this population. Some adjustments were added to produce a finalized model in Series C, with positive results. Overall, these three series of studies indicated that the model is feasible, deliverable, and efficacious in reducing depression in older participants. In addition, results showed a positive impact on participants' functional ability, especially in the areas where the impairment is reversible, such as social functioning and activities of daily living. This model has implications for future applications that encourage the development of alternative models of intervention capable of meeting the unique needs of special populations

Chapter 10. Dignity in Design: The Siting and Design of Community and Shelter-Based Health Facilities for Homeless Persons

Introduction Community and shelter-based health services have emerged as one of the main strategies for improving the health of homeless persons in Canada. One of the earliest shelter-based health services, the Seaton House Annex Harm Reduction program in Toronto, has been in operation since 1997, and community and shelter-based health services have since followed in cities across Canada. These services are intended to reduce the impact of barriers preventing homeless persons from accessing s..

Professionalization of hospice volunteer practices: what are the implications?

Volunteers are increasingly considered as core members of interdisciplinary palliative care teams, and thus no longer “informal providers.” The definitive trend towards formalizing the role of hospice volunteers is indicated not only by national work to develop best practices (Ferris et al., 2002), but also by efforts of the Canadian Council on Health Services Accreditation to develop quality indicators for accrediting volunteer agencies. This movement emerged from a need to coordinate, define and standardize the role of volunteers in palliative care settings, as well as to manage organizational resources and maintain standards of excellence. The purpose of this forum is to highlight the possible impact of this development on the nature of volunteer contribution to end-of-life care.</jats:p

Introduction

Why This Book? Stereotypical images of homeless persons, such as those of 'junkies', 'squeegee kids' or 'bag ladies', shape popular understandings of homelessness but obscure the scope and diversity of Canada's homeless population. Over the past thirty years, the retreat of the federal government from social housing, along with reforms to social welfare programs and health care, has contributed to a growing homelessness crisis that affects tens of thousands of people every year (Hulchanski et..

Homelessness & Health in Canada

Homelessness & Health in Canada explores, for the first time, the social, structural, and environmental factors that shape the health of homeless persons in Canada. Covering a wide range of topics from youth homelessness to end-of-life care, the authors strive to outline policy and practice recommendations to respond to the ongoing public health crisis. This book is divided into three distinct but complimentary sections. In the first section, contributors explore how homelessness affects the health of particular homeless populations, focusing on the experiences of homeless youth, immigrants, refugees and people of Aboriginal ancestry. In the second section, contributors investigate how housing and public health policy as well as programmatic responses can address various health challenges, including severe mental illness and HIV/AIDS. In the final section, contributors highlight innovative Canadian interventions that have shown great promise in the field. Together, they form a comprehensive survey of an all too important topic and serve as a blueprint for action

Homelessness & Health in Canada

Homelessness & Health in Canada explores, for the first time, the social, structural, and environmental factors that shape the health of homeless persons in Canada. Covering a wide range of topics from youth homelessness to end-of-life care, the authors strive to outline policy and practice recommendations to respond to the ongoing public health crisis. This book is divided into three distinct but complimentary sections. In the first section, contributors explore how homelessness affects the health of particular homeless populations, focusing on the experiences of homeless youth, immigrants, refugees and people of Aboriginal ancestry. In the second section, contributors investigate how housing and public health policy as well as programmatic responses can address various health challenges, including severe mental illness and HIV/AIDS. In the final section, contributors highlight innovative Canadian interventions that have shown great promise in the field. Together, they form a comprehensive survey of an all too important topic and serve as a blueprint for action