1. Palliative Education And Care for the Homeless (PEACH): A Palliative Care intervention for marginalized & vulnerably housed populations in Toronto Naheed Dosani MD, CCFP

2. A social justice issue... The narrative

3. A social justice issue... The data

4. A Snapshot: Toronto’s Homeless ●homeless: 5200 o in streets: 450 ●1+ chronic disease: 75% ●HCV: 28x | Heart Disease: 5x | Cancer: 4x ●severe depression: 30% ●elderly: 10% Street Needs Assessment, City of Toronto, 2013 Early Onset Illness and Mortality Group, 2011 Street Health Report, 2007

5. Health and Housing in Transition Study, 2010

6. A Snapshot: Toronto’s Homeless Vulnerably Housed: ●>50% income = rent o monthly income [after rent] = $470 ● Housing : o poor conditions o instability, recent or episodic homelessness o comorbidity prevalence comparable to homeless Health and Housing in Transition Study, 2010 Hwang, 2010

9. Homelessness at EOL ●Life expectancy: 34-47 yo ●Mortality rates: 2.3-4x ●2020: 58 000 new seniors/yr [US data] ●Location of death: o transitional spaces o residential dwellings o ED o in-hospital [34-59%] Hwang et al, 2009 Cagle, 2009 Podymow et al, 2006

10. How it all started...

11. PEACH ●Mobile ●Shelter-based service ●Early Palliative Care

12. Our goals... 1. Provide high quality early, integrated palliative care 2. Support and be a resource to ICHA’s primary care providers in the provision of EOL care 3. Provide support to mainstream Palliative Care services in the provision of EOL care

13. Our goals... 4.Increase confidence among community homeless agencies to support clients facing EOL 5.Advocate for accessible, high-quality, early and integrated Palliative Care 6.Advance the body of knowledge for the delivery of Palliative Care for homeless & vulnerably housed populations

14. Results... ●Launch in July 2014 o Media exposure ●Collaborative partnerships: o TC CCAC, SMH, TLCPC, Toronto Grace, Kensington Hospice & more to come! o Hospice Toronto, Anishnawbe Health, Church of Saint Stephen-in-the-Fields & more!

15. Results... ●Care provision: o 25+ patients o Models of care o Early vs late o Malignant vs non-malignant o M vs F o Geography o Outcomes

16. Results... ●Advocacy: o Academia o Service agencies o Blog posts, social media, commentaries o Bill M-456 - Pan-Canadian Palliative/EOL Strategy ●Research

18. http://www.icha-toronto.ca/sites/peach