I was very proud to use the word “apotheosis” on today’s podcast. See if you can pick out the moment. I say something like, “Palliative care for people experiencing homelessness is, in many ways, the apotheosis of great palliative care.” And I believe that to be true. When you think about the early concepts that shaped the field, you can see how palliative care for persons experiencing homelessness fits like a hand in a glove: total pain envisioned by Cicely Saunders, which even its earliest sketches included social suffering like loneliness; or Balfour Mount, who coined the term “palliative care,” lamenting the cruel irony of our care for the dying, and the desperate need to create programs to reach more people experiencing suffering.

Today we talk with Naheed Dosani, a palliative care physician at St. Michael’s Hospital in Toronto, and health justice activist. His story, which he shares on today’s podcast, is remarkable. Just out of fellowship, Naheed built a palliative care program for homeless persons called the Palliative Education and Care for the Homeless (PEACH) Program. This podcast is a complement to our prior podcast on aging and homelessness with Margot Kushel. Today we discuss:

What is the best terminology? Homeless? Homelessness? Houseless? Marginally housed?
What makes palliative care for people experiencing homelessness challenging? What makes it rewarding?
What is unique about the practice of palliative care for people experiencing homelessness? We discuss the principles of harm reduction, social determinants of health, and trauma informed care. Major overlap with substance use disorder issues, which we have covered recently (and frequently) on this podcast.
How are the health systems designed or not designed to meet the needs of people experiencing homelessness?
What are the equity issues at stake, and at risk of being cut, both in Canada and the US?

Many more links below. And I had a blast playing Blinding Lights by that Toronto band The Weekend.

Enjoy!

-Alex

End Well Talk

https://www.youtube.com/watch?v=eG4QE-hfPQU

Resources on the PEACH Program

Program Review Paper – A recent publication in Longwoods Healthcare Quarterly reviewing the PEACH model.
https://pubmed.ncbi.nlm.nih.gov/37144698/
Promising Practice Recognition – PEACH was named a Promising Practice in equity-oriented palliative care as part of a national initiative funded by Health Canada, operated by Healthcare Excellence Canada & the Canadian Partnership Against Cancer.
https://www.healthcareexcellence.ca/media/z3jifqqd/pp-peach-en-2024-v2.pdf
Toronto Star Feature
https://www.thestar.com/life/together/people/dr-naheed-dosani-started-peach-to-provide-palliative-care-for-homeless-and-vulnerably-housed-populations/article_c56d8f45-cbe9-522e-9554-46778bf50407.html
CityNews Toronto Feature
https://toronto.citynews.ca/2022/08/08/peach-team-palliative-health-care-homelessness/

Psychosocial Interventions at PEACH

In addition to medical care, PEACH also runs two key psychosocial interventions for our clients:

PEACH Grief Circles – Structured spaces for workers in the homelessness sector to process grief. CBC covered this a few years ago, including a radio segment feature on CBC White Coat, Black Art (which you can access at the below link).
https://www.cbc.ca/radio/whitecoat/palliative-care-team-helps-the-homeless-die-with-dignity-a-healing-circle-helps-them-grieve-1.5048409
PEACH Good Wishes Program – A program that provides meaningful gifts for unhoused individuals who are terminally ill.
https://www.cbc.ca/news/canada/toronto/toronto-homeless-palliative-holidays-1.5407360

Kensington Hospice & 'Radical Love' Equity-Oriented Hospice Palliative Care

Naheed Dosani also serves as the Medical Director of Kensington Hospice, Toronto’s largest hospice. There, he helps run an innovative program called 'Radical Love' Equity-Oriented Hospice Palliative Care, which provides low-threshold, low-barrier access to hospice care for structurally vulnerable individuals (e.g., those experiencing homelessness). The program also operates via a partnership with the PEACH Program.

As a result of the 'Radical Love' program at Kensington Hospice: At any given time, Kensington Hospice has evolved from caring for structurally vulnerable individuals <2% of the time...to now serving structurally vulnerable people 40–50% of the time.
Canadian Press Feature – A powerful and widely shared piece on our work.
https://www.cbc.ca/news/canada/toronto/ont-homeless-palliative-1.6901396
Promising Practice Recognition – Kensington Hospice’s Radical Love program was also recognized as a Promising Practice by Healthcare Excellence Canada & the Canadian Partnership Against Cancer.
https://www.healthcareexcellence.ca/media/gxmf021n/pp-kensington-hospice-en-2024-v3.pdf

National Canadian Efforts in Equity-Oriented Palliative Care

Canada is investing in equity-oriented palliative care through the Improving Equity in Access to Palliative Care (IEAPC) Collaborative. This is a multi-year funded initiative that supports 23 equity-oriented palliative care models for people experiencing homelessness and structural vulnerabilities across Canada.

https://www.healthcareexcellence.ca/en/what-we-do/all-programs/improving-equity-in-access-to-palliative-care/

PC for People Experiencing Homelessness: Naheed Dosani

GeriPal - A Geriatrics and Palliative Medicine Podcast