Grant: Operating Grant

People impacted by issues such as inadequate housing, racism, substance use and mental illness continue to experience persistent health and health care inequities and challenges in accessing health care services. Indeed, access to care at the end of life (EOL) is especially problematic for those who are "structurally vulnerable". Many of these vulnerable people are admitted to hospitals that do not provide them with quality care; they do not have strong family and social networks, and lack the financial resources to enhance their care quality. Some people end up dying in places unfit for human habitation (e.g., outdoors, vehicles, etc.), and/or in shelters or transitional housing either alone or cared for by workers who have limited training. There have been recommendations to improve quality end of life care but little evidence to inform the development of services that would enhance access to quality care at the end of life. In this three year study we will observe and interview structurally vulnerable and marginalized people, their support persons, and the providers that care for them to better understand the experience that they have in accessing health care services at the EOL. We will also interview key stakeholders to better understand how organizational, social and political contexts influence access to quality EOL care. Our aim is to inform the development of targeted interventions and equitable health services and policies in order to improve access to care for people who are at the EOL.