Care for some of the most vulnerable dying people is essential ministry. An extended version of a Jan/Feb 2023 print article.
“When asked if you're dealing with a terminal illness, where do you want to be? Most Canadians say home. What do you do when you're homeless? What do you do when you're vulnerably housed?” asks palliative care doctor Naheed Dosani in an introductory video for Journey Home Hospice. “Being sick is hard enough but being sick and dying on the street is even harder.”
Dosani sought to address this very concern as he encountered the skyrocketing number of homeless-involved people dying alone, on park benches and alleyways. According to his TEDx talk in 2016, a Canadian living on the streets is as much as four times likelier to die than the rest of the population, and their life expectancy is at most 47 compared to the national average of 82.
Dosani’s answer? Bring quality end-of-life care to those living on Toronto's streets, making home visits wherever his patients find themselves.
His main work involves mobile units. Along with a nurse, he visits those park benches and alleys where he can meet patients with terminal illness and offer them what comfort he can. Similar mobile palliative services for homeless-involved people have been set up in Calgary and Victoria. The Calgary program has struggled with funding and no longer updates their online information.
The Ottawa Mission is an example of responding to that need with brick and mortar. The Mission dates back to 1907, when it was founded by a group of Christian business leaders concerned by increasing homelessness in the city.
In 2001 Diane Morrison, executive director at that time, encountered a patient who had been evicted from a hospital palliative unit for his inability to follow their rules. Morrison set up a bed for him in the mission’s prayer room, which a staff member would have to put away every morning. Naturally, a more sustainable solution beckoned.
With the help of Ottawa Inner City Health, Carefor Health and Community Services, the Champlain Local Health Integration Network and a federal government grant, Morrison added an entire hospice wing to the mission. She herself retired in 2013, but through two decades of operation the Diane Morrison Hospice carries on her legacy, offering 20 to 21 comfortable rooms for street-involved people with terminal illnesses.
In 2018 Dosani brought Morrison’s solution to Toronto after encountering a similar situation – a homeless-involved person with a terminal illness who had nowhere to die with the care and love they needed. This person was a domestic abuse survivor who had developed an addiction to pain medications and later contracted terminal cancer. Dosani founded the Journey Home Hospice along with Inner City Health Associates, the Saint Elizabeth Foundation, Hospice Toronto, the Homes First Society and corporate donors.
The downtown facility offers 10 comfortable bedrooms in a well-furnished and spacious apartment and offers services such as spiritual care, physical and psychosocial therapy, 24/7 access to doctors and nurses, personal support workers and extensive training for volunteers and staff.
That staff continues to work for patients’ dignity after they have died. Current director of care Felicia Kontopidis RN recently highlighted her team’s efforts with coroners’ offices and funeral homes to ensure that patients received timely, dignified burial services and that their next-of-kin are found and contacted (Nurses’ Voices podcast, May 2022).
Yetty Olowabi, the current hospice director at the Diane Morrison Hospice, speaks of the similarly comprehensive care offered at their Ottawa facility. She lists both practical and mental health nursing, spiritual care and peer support alongside the palliative care doctors that serve the facility.
“It’s a huge circle of care,” she says. “We want to make sure that we are providing our clients with holistic care.”
She goes on to say that this holistic care in a stable home can make all the difference. The hospice takes in patients with much longer prognoses than standard palliative units – three to six months as opposed to two weeks. But staff expect that patients might stay much longer.
“For clients who've been street involved, when they come into a setting like ours, there's more stability,” says Olowabi. “They get their meds, they get love, dignity and all the things that are lacking.” They no longer experience homelessness, and are therefore far less susceptible to the health risks posed by homelessness. “So definitely, they would outlive those three to six months.”
Spiritual care director Dave Kornelson, who served as a pastor himself before turning to clinical chaplaincy, says that his work is part of that holistic home-making that reduces the risk of early death. “One of the great things that [spiritual care] can bring is the restoration that they can have hope,” he says, “where just a simple prayer, and seeing God answer that prayer, all of a sudden revitalizes them in a way that we can't really measure, but you can see.”
Olowabi tells of one client who came to the hospice diagnosed with a brain tumour, survived with the tumour for eight years and ultimately moved to a long-term care centre because the growth had disappeared.
That’s an extreme story. For most clients, “healing” means “restoration, togetherness, where they're more at peace, acceptance, even willing to forgive,” says Olowabi. For this reason, she and Kornelson ensure that faith, spirituality and community are fully integrated in that holistic "circle of care” at the hospice.
Information on the hospice in the Ottawa Mission’s 2019-2020 Impact Report highlights the role of spiritual care, which patients and their families can “receive in their final days with compassion and dignity.” It adds that the “Spiritual Care team ensures memorials are held for all those who pass away.”
The team and the hospice are integrated into Ottawa Mission’s expressly biblical outlook. The Impact Report’s opening letter by board president Matt Triemstra and CEO Peter Tilley quotes 1 Peter 4:10: “’Each one should use whatever gift he has received to serve others, faithfully administering God’s grace in its various forms.’”
Kornelson applies this commission with another passage, which serves as the hospice’s guiding light. He quotes James 2:13: “mercy triumphs over judgment.” He adds, “We believe it's never too late to walk towards the freedom and hope that we find in Christ.”
Both hospices are open to multiple forms of support. See the get-involved sections on their websites (Diane Morrison Hospice and Journey Home Hospice) for more information.
Matthew Neugebauer is a Toronto writer and a digital marketing co-ordinator for Salt + Light Media. Last summer he interned at Faith Today. Photo: Journey Home Hospice.