Grant: Travel Awards - Institute Community Support

Older people experiencing homelessness are often excluded from competent palliative care. While there is a small but growing network of Canadian programs aimed at supporting the end-of-life care needs of older people experiencing homelessness (OPEH), little is known about the unique needs, practices, and innovations required to improve the delivery of competent and inclusive palliative care services to the growing number of older homeless people who will require such support. To address this gap, we conducted a content analysis of 75 Canadian palliative care and homelessness policy documents, and an environmental scan of practices consisting of qualitative interviews, organizational surveys, policy document reviews, and site visits at seven specialized hospice programs across Canada with mandates to provide end-of-life care to OPEH. Our findings affirm the invisibility of end-of-life care in Canadian policy frameworks in the homelessness sector, highlight the unique end-of-life and bereavement needs of OPEH, and illuminate how practices shape hospice spaces to create a sense of belonging at end-of-life. More specifically, we found that specialized hospices identified four prevalent and intersecting needs among older homeless people requiring end-of-life care: mistrust and trauma, substance use, connection and disconnection, and uncertain health trajectories. These hospices responded to these unique needs with practices such as trauma-informed practice, harm reduction, Indigenous cultural inclusion, and addressing the social determinants of health. These practices informed the physical space such as the presence of smoking patios, and access to cultural resources such as Indigenous medicines, which appeared to work together to create inclusive spaces for a population typically excluded from palliative care. This presentation will include recommendations to expand the scope and breadth of policy, programs, and practice in this critical area.