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CMAJ - Bringing palliative care to the homeless

Published: 5 April 2011

Canadian palliative care programs are generally created with the needs of mainstream society in mind. Though these systems attempt to accommodate everyone, the unique challenges of serving marginalized populations make this difficult. And there is perhaps no population more challenging to assist in dying than the homeless. [...]

An analysis of 28 terminally ill people who died [in] hospice found that providing palliative care in a shelter can not only be effective, but can also save money. The patients stayed in care an average of 120 days, at a projected savings of $1.39 million compared to similar stays in mainstream care locations.

"The homeless terminally ill have a heavy burden of disease including physical illness, psychiatric conditions and addictions," the report states. "Shelter-based palliative care can provide effective end-of-life care to terminally ill homeless individuals at potentially substantial cost savings."

The lead author of that report was Dr. Tiina Podymow, an assistant professor of nephrology at the Ï㽶ÊÓƵ Health Centre in Montréal, Quebec. The homeless people who accessed the in-shelter hospice were incredibly grateful to have a bed and people to care for them in an environment where they felt comfortable, says Podymow.

"They have a lot of addictions and many are chronic smokers, so hospitals are not the best place for them to die in character," says Podymow. "They can’t do things that were part of their lives."

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