End of Life Care With People Experiencing Homelessness

Abe Oudshoorn, RN, PhDAssistant Professor, School of Nursing, Western University

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Where are the homeless?

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Who are the Homeless?

• 66% mental health challenges• 33% addictions

• But, causes of homelessness are as many as the number of people experiencing homelessness

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How many are homeless?

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Why are they Homeless?

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How is their health?

LHSC Emergency

St Joseph’s Urgent Care

Health Zone

CMHA – Access Team

CCAC

London Crisis Pregnancy Centre

Youth Action Centre

Middlesex London Health Unit

At’ Lhosa

Regional HIV/AIDSConnection

London Public Library

Addiction Services of Thames Valley

EMSMen’s Mission

Street Scape

Centre of HopeWithdrawal Management

Chiropractors@COH

Centre of Hope Family Health Team

Women’s Community House

DOCS – Dental Outreach

Bethesda Centre EMDC

LHSC Women’s Health

St Leonard’s

My sister’sPlace Salvation Army-

Mobilizing Hope

Pharmacies

Methadone Clinics

LIHCQuinton Warner

WotchSOAHC

Regional Support Associates

Infectious Disease Care

John Gordon HomeDale Brain Injury Service

CAS

RMHCWhat health care do they access?

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Is their health care appropriate?

• ED• Walk-in clinic• CHC

• Home care?

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What is this costing us?

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Behavioural Barriers?

• Or policy barriers?

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What constitutes ‘palliative’?

• “life-threatening illness”, “serious illness”

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Pain and addiction

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Treatment solutions

• People, most often, will die how they lived.

• Harm reduction• Mental health support• Behavioural considerations

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Structural Solutions

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

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Functional Example

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Questions