Michael Wood, O’Brien Institute for Public Health
Dec. 18, 2017
They're homeless, they're dying, and they deserve dignity
UCalgary and frontline agencies 'imagineer' better palliative care for vulnerable populations
Ben was chronically homeless, passing in and out of Bonnie Larson’s life, and his hands were showing the wear of too many winters.
“He lost the tips of his fingers to frostbite — more than once,” says Larson, a family doctor who was doing street outreach with Calgary Urban Project Society (CUPS) at the time. “He would disappear and then he would return with more frostbite.”
He was living on the edge, and then he fell. “One day he came to me, and he had been discharged from hospital with a palliative diagnosis of metastatic cancer. He was told he was going to die and to see a family doctor," says Larson.
“I was horrified. Terrified. It’s that feeling of panic because I know the guy in front of me just received a life-altering diagnosis. He has a million questions, he thinks it’s entirely his fault because of his lifestyle, and he is discharged to the street. To a tree. To a bridge.”
Larson and her team scrambled to connect Ben to care and supports — if for no other reason than to ease his agony. He was in serious pain, and neither prescriptions nor referrals were offered. “He died in pain crisis in hospital. It was devastating. And he was in his mid-40s.”
The world may have forgotten Ben, Larson has not.
Dozens of care providers, agencies, frontline organizations and community members came together for a day of ‘imagineering’ to find solutions, address health inequities and break down the barriers to palliative services that would have allowed Ben to die with dignity. A town hall was put on for the Calgary Allied Mobile Palliative Program (CAMPP), a small team of health professionals who deliver that kind of care to the city’s most vulnerable. They help clients manage pain. They help them navigate the health system. They give a voice to those who may otherwise not be heard.
CAMPP is a grassroots program catalyzed by Larson’s team, Street CCRED (Community Capacity in Research, Education, and Development), which operates with support from the O’Brien Institute for Public Health at the University of Calgary’s Cumming School of Medicine (CSM).
Now in its second year, CAMPP is only too familiar with these particular needs in Calgary. Dr. Simon Colgan, an O’Brien Institute member and a physician working with CAMPP, has noted that of the roughly 900 chronically homeless people living in Calgary, more than half live with complex medical conditions.
“We’re trying to imagineer better end-of-life care for those suffering from terminal illness,” Colgan explains. “We already work with local organizations like CUPS, the Drop-In Centre, Alpha House, the EMS Centre City Team and others, however CAMPP felt it was also time to ask the community what their experiences are working with palliative clients and what else we can learn.”
The event brought together The Seed, Hospice Calgary, YWCA, CUPS, Inn From the Cold, the Calgary Homeless Foundation and more to tackle issues such as harm reduction in palliative care settings, how the community can improve access, and where clients should die.
“Palliative care is just part of the continuum of care we need to offer,” says Kathy Christiansen, executive director of the Alpha House who has worked with vulnerable populations for 24 years. “We should be able to provide it and normalize that way of thinking.”
Rob Latham is the manager of client services at the Drop-In Centre, one of Calgary’s most visible service providers working with homeless populations. He sees the town hall as not just a discussion among care providers itching to see systemic change, but something bigger.
“It’s a movement towards not trying to take people and put them in a facility and expect them to thrive, but actually look at the individual, assess their needs and build support around that individual, and I think that’s a really great focus for this room,” he says.
“When somebody is so marginalized, the palliative process is already challenging, and for the CAMPP team to bring a humane perspective back to that, it’s about the marriage of medical and humane care.”
Bonnie Larson is a clinical assistant professor in the Department of Family Medicine, CSM. Simon Colgan is a clinical lecturer in the Department of Oncology, CSM.