PEACH - Palliative Education and Care for the Homeless

“Emotionally I was alone, you know? But now I have a team fighting with me… with my disease. It makes me so strong.” PEACH Palliative Client

Each year, approximately 200,000 people across Canada experience homelessness, between 8,000 and 9,000 of whom live in Toronto. Palliative Education and Care for the Homeless, or PEACH as it reads is a mobile, shelter-based consultation, support and education program designed to provide early palliative care for vulnerably housed and homeless individuals in Toronto.

PEACH is a supportive palliative service fostered by Inner City Heath Associates (ICHA). Dr. Naheed Dosani, a palliative care specialist at St. Michael’s Hospital in Toronto, has been working the PEACH program.

“What we are doing with PEACH is taking inner city health services and linking them with the latest thinking in palliative care.

“Being sick is hard. Being sick and homeless can be even harder.”

Dr. Dosani, a member of a large network of inner-city health physicians, is part of a program that takes end-of-life care to the homeless and vulnerably housed wherever they are situated.

“Most people want to pass away at home with family around them,” says Dosani, “that sentiment is no different for the patients PEACH aims to treat. The only difference is that our patients’ homes are often a shelter and their families may be other shelter clients and staff.”

But what happens when these people are dying? Where do they find care in their final days?

People can be on the streets, they can be in shelters, they can be couch surfing, they can have supportive housing and then lose their job, get an illness and be back on the streets. PEACH is applying this knowledge to the needs of a vulnerable homeless population. The key to the PEACH model has been its focus on promoting and protecting the dignity and care goals of patients within a shared decision-making process. PEACH’s approach is the interdisciplinary and collaborative way in which it delivers palliative care. Palliative Physicians, Nurses, Social Workers, on the front lines, seeing patients.

PEACH has also been paving the way toward improving the lives of homeless and vulnerably housed individuals while keeping the values of social justice, equity and compassion close in mind. To advocate for accessible, high quality, early, integrated palliative care for homeless and vulnerably housed populations

Since the outbreak of Covid 19 the PEACH team has seen their patient roster double since the pandemic hit. Before the pandemic, the group had roughly 50 patients on their roster and now more than 100 are under their care.

In addition, Covid 19 has presented further challenges as many services have moved online which makes accessing medical care difficult. Working alongside patients is the key to success for the PEACH program. Helping patients successfully navigate the new challenges added to the health care system. Sasha Hill, Coordinator, Palliative Education and Care for the Homeless (PEACH) & Community Nurse Inner City Health Associate: “If you get a new diagnosis of cancer and you are living in the shelter system, and trying to coordinate something like a specialist appointment… if you don’t have a phone how are you supposed to get to those visits?”

The support PEACH offers take many forms. Sometimes it is a simple as a weekly check-in, picking up prescriptions or arranging meals. Other times staff will help patients arrange transportation for appointments or help them with virtual consultations by bringing a phone to them wherever they are in the city.

Sasha explains, “If you can get somebody feeling better and feeling like they have a quality of life where they want to continue to live for the months that they have, for us that is the best.

When someone dies with no fixed address, those who aided in their care may share the experience of grieving in a group, a healing circle, using the “4Rs”: remember, reflect, recover and plan to reinvest.

“Every day I am so thankful and thank God”: PEACH Palliative patient

Back to top