In Canada, we often think of good health and access to health care as basic rights, available to everyone. However, this is not true for the 150 000 to 300 000 people who are homeless or at risk of homelessness.

Chronic health conditions, like diabetes and high blood pressure, as well as life-limiting illnesses, like cancer, are a reality for people who are homeless. In fact, men who are homeless live, on average, to somewhere between 42 and 52 years old when for the general population life expectancy is near 80 years. Their rate of death is 3 to 4 times higher than the national average in Canada. 

Not being able to access health care means that people who are homeless and face life-threatening and chronic conditions are not able to receive palliative care. The goal of palliative care is to help people with life-limiting illness be as comfortable as possible, to manage their pain and other symptoms well, and to help them maintain a good quality of life in four areas: physical, psychological, spiritual, and social. 

There are many reasons why people who are homeless or at risk of homelessness do not have access to palliative care. They often do not trust health care workers because they have had bad experiences with them in the past. Many health care services, particularly end-of-life care services, have conditions, such as requiring people to be free of substance use or requiring a permanent address. Also, health care providers often do not understand the challenges of being homeless or vulnerably housed.

A palliative approach to care recognizes a person’s unique life situation, including their homelessness. It is based on the idea that palliative-like care should be offered as early as possible, not just at the end-of-life. It is also provided not just to people with life-limiting illnesses but also for people with chronic illnesses. A palliative approach can be offered by anyone caring for or working with an individual, not just palliative care specialists.

Social care workers support people experiencing homelessness who are chronically ill or nearing their end-of-life work in a wide variety of settings. These workers cover many types of roles which include but are not limited to:

• Peer support workers (with lived experience)
• Outreach and harm reduction workers
• Addictions workers
• Supportive housing workers
• Volunteers
• Case coordinators
• Program coordinator
• Shelter workers
• Legal clinic staff
• Drop-in centre staff
• Employment workers
• Harm reduction site workers

Workers are in a unique position to provide a palliative approach to care. Every day they work in shelters, drop-in centres, or on the streets, to build trusting relationships with people who are homeless. Workers have a clear understanding of the life circumstances and difficulties that people who are homeless face when accessing health care. Some workers have lived experience with homelessness.

Many workers take a harm reduction approach to care in order to build relationships with people who are homeless. They do this with the goal of building trust and trying to assist them in getting better access to care, including end-of-life care. However, this can be frustrating and daunting for workers when they may not have all of the skills and knowledge that they need in order to discuss dying and death, palliative care, and a palliative approach. 

This resource was developed with and for workers across Canada who support people who are homeless.  It is designed to provide useable and practical information about providing a palliative approach to care while building on the knowledge and expertise workers already have about harm reduction approach, relationship development, and meeting people where they are at. It is currently under development as feedback is received from courses held across Canada. The content of the site may change over time to reflect this feedback.