“Some of us are more privileged even in death. It’s hard to witness,” says Justine McIsaac, Coordinator, Consumption & Treatment Services. “Strict rules govern access to supportive palliative care, like hospice. When people can’t meet those requirements because of substance use or other challenges, they end up suffering longer in the community.”
For people who are vulnerably housed or experiencing mental health and substance-use challenges, proper end-of-life care has often been out of reach. Stigma and a health system built around fixed addresses have historically blocked access.
Over the past year, the FLA OHT and a group of local partners, including KCHC, have created a direct referral pathway that allows shelter workers and Integrated Care Hub staff to connect people directly to a new palliative care community outreach team. This approach is opening the door to care people were previously excluded from, including primary care and pain management delivered in shelters, at the ICH, and to people living in cars and encampments.
“Many of these barriers are not unique to palliative care but affect health care more broadly,” explains Megan Conboy, KCHC’s Palliative Care Coordinator. “Factors like not having a primary care provider, lacking transportation to appointments, or having no support person or advocate to help navigate a complex system can make care inaccessible. A lack of preventative care may mean conditions go undiagnosed or untreated, and when care is needed, services normally provided in a person’s home may not be available to someone who lives rough or doesn’t have access to a phone.”
Front-line workers supporting vulnerable community members are often the first to see these challenges. Because they have built trust and rapport, they can notice changes in a person’s health or concerns that may not be obvious to health care providers. By involving front-line staff in the referral pathway and equipping them with knowledge of local resources, care is improving. Combined with the outreach services of Queen’s Palliative Medicine’s Community Outreach Team, some of these barriers are being reduced.
“Palliative care, particularly for people who use illicit substances, is complicated. Not many people know how to support those with complex substance-use challenges, and as a result, people often get left behind,” Justine explains. “It’s crucial that we educate ourselves and recognize that every individual is different, with unique needs. In doing so, we must adapt to provide care that is dignified and respectful.”
Funded in part by Healthcare Excellence Canada, the FLA-OHT Palliative Care Partnership Table includes several subgroups working to transform how end-of-life care is delivered in primary care, for vulnerable populations, and within Indigenous communities. Indigenous Community Development Worker and Grandmother, Kathy Brant, also serves as an advisor.
The collaborative partnership is supporting training opportunities for regional staff, with Megan, Justine, and Grandmother Kathy Brant actively involved.
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