Introduction to a Palliative Approach to Care

By applying a palliative approach along with a harm reduction approach to working with people who are homeless and who have a chronic or life-threatening illness, workers will be in a better position to advocate for their health care needs.

Palliative care is a term that is more well-known than a palliative approach to care but it is important to understand the differences as a palliative approach is a better fit than palliative care with the support provided by workers and the unique needs of people who are homeless.

Palliative care is a type of care offered by health care providers which aims to help people with life-ending illnesses 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 of need: physical, psychological, spiritual, and social. 

A palliative approach to care is not a specific service. Instead, it is an approach that can be taken by anyone – not just health care providers – to improve the lives of those with a chronic or life-limiting illness. Taking a palliative approach provides a sense of control to these individuals as well as their family and friends. It focuses on the individuals and how to maximize their quality of life, rather than just focusing on the goals of a treatment. 

The main differences between palliative care and a palliative approach to care are that a palliative approach to care:

  • is offered to people with life-limiting and chronic illnesses not just life-ending illnesses. This is especially important for people who are homeless as they commonly experience chronic health conditions that can affect their quality of life.
  • is not reserved until the end stages of an illness, but instead is applied earlier to provide active care focused on making sure the person is comfortable
  • is focused on improving the quality of life for not just the person who is ill but also for their family and friends. A person who is homeless may have people who support them that may not fit within the role of a traditional family or friend.
  • can be provided in any setting, like a shelter or drop-in centre, not just in a health care setting like a hospital or doctor’s office by anyone, not just health care providers. This means better access to care for people who are homeless as the care is provided where they are and by people with whom they are more likely to trust.
  • uses an open approach to reducing suffering rather than putting conditions on receiving comfort, such as abstaining from drug or alcohol use. A significant number of people who are homeless also have substance abuse issues which means they may experience from severe withdrawal symptoms, such as pain and irregular heartbeat which may worsen the symptoms of their illness.
  • promotes understanding of the person and their family and supports loss and bereavement. 

The goals of a palliative approach to care are to:

  • improve the quality of life in four areas of need: physical, emotional, psychosocial, and spiritual
  • reduce an individual’s pain and manage their symptoms regardless of their substance use
  • preserve the person’s sense of control throughout the care process

With a palliative approach to care, it is important to:

  • make sure the person and their family and friends are met “where they are at”, which means helping them to deal with the health situation when, where, and how they want
  • include the person and their friends/family in the care process, throughout the entire journey
  • ensure that care is supportive and protects the person’s dignity, including their right to make decisions and be communicated with openly about their care
  • respect the social and cultural needs of the person and their family and friends
  • consider everyone involved as partners in the decision making process, not just the health care providers

Workers often apply a harm reduction approach in their care for people who are homeless. This approach provides a starting point for using a palliative approach given their common, timing, principles and consideration of a person’s life circumstances.

  • Harm reduction is an approach that tries to decrease health and social harms that come from addiction and substance use, without needing those who use substances to stop using them. It gives people choices about how to minimize harms through non-judgmental and non-coercive strategies that improve their skills and knowledge to live safer and healthier lives.

Both approaches have similar:

  • Timing – They are applied as early as possible and consistently throughout interactions with the person and their supports 
  • Principles – They both work to:
    • preserve and promote the dignity and quality of life of the person
    • meet the person “where they are at”, such that both approaches are applied in a setting and at a pace that best suits the person
    • respect the individual’s right to make informed decisions about their care
  • Context – Both approaches consider the impact of the person’s life circumstances and history on the acceptance of care and on their experience of symptoms
  • Harm reduction does not try to influence any decision or preferences of a person, which contrasts with a palliative approach that involves encouraging the person to make certain choices over others, especially in areas that might impact or improve their care. For instance, both approaches recognize that people who are homeless may have bad experiences with health care providers which make them reluctant to get medical treatment for an illness or condition. A harm reduction approach would not involve addressing the decision to avoid medical attention, whereas a palliative approach may involve encouraging the person to seek medical treatment and providing support in accessing care in a way that is most comfortable for them.
  • Harm reduction aims to reduce the harmful effects of the substance abuse behaviour by minimizing death, disease and injury from high risk behaviours. A palliative approach aims to reduce the effects of the disease or condition on the person’s quality of life.
  • Harm reduction aims to minimize risk for both the people involved and the community around them.