A Hospice Like A Hospice Like No Other! No Other!

Build the caseBuild the case

Homeless people were Homeless people were dying on the streets, dying on the streets, in shelters and in in shelters and in substandard housing.substandard housing.

Barriers to mainstream Barriers to mainstream palliative care palliative care services for the services for the homeless population homeless population were were

1.1. addictions addictions 2. mental illness 2. mental illness 3. their chosen lifestyle 3. their chosen lifestyle

Requests from clients to Requests from clients to avoid hospital useavoid hospital use

Gather Public SupportGather Public Support

Find champions in the health Find champions in the health care system – public health care system – public health street nurses, local street nurses, local community health centres community health centres and representatives from the and representatives from the mainstream health care mainstream health care systemsystem

Obtain the support of the Obtain the support of the “mainstream” Palliative Care “mainstream” Palliative Care CommunityCommunity

Make the cause and the Make the cause and the dream publicdream public

Get on the public health Get on the public health agenda for the city of Ottawaagenda for the city of Ottawa

Develop a VisionDevelop a Vision

Recognized need to change how the Recognized need to change how the homeless community deals with homeless community deals with death and dyingdeath and dying

Need for a facility which embraces Need for a facility which embraces “street culture”“street culture”

Need to integrate services for the Need to integrate services for the homeless with mainstream palliative homeless with mainstream palliative carecare

Keep the focus on the people that need the service

Build the ModelBuild the Model

The Mission Hospice canThe Mission Hospice can Provide housing for Provide housing for

those who have nonethose who have none Be flexible, not many Be flexible, not many

rules or regulations to rules or regulations to followfollow

Allow clients to retain Allow clients to retain lifestyle and remain lifestyle and remain part of their part of their communitycommunity

Support a focus on Support a focus on living - not on dyingliving - not on dying

The Ottawa ModelThe Ottawa Model

Ottawa Inner City Health ProjectOttawa Inner City Health ProjectSuperior health service to the homeless Superior health service to the homeless

populationpopulation

Supported by all the shelters in the citySupported by all the shelters in the city

Services offered palliative care, managed Services offered palliative care, managed alcohol, convalescent carealcohol, convalescent care

Incredible partnershipsIncredible partnerships

Model of Service DeliveryModel of Service Delivery Based on partnership Based on partnership

between many between many organizationsorganizations

Based on committed Based on committed ongoing relationship ongoing relationship between Mission between Mission (housing, food, (housing, food, spiritual care, spiritual care, transportation, etc) transportation, etc) and Ottawa Inner City and Ottawa Inner City Health (health care)Health (health care)

OICHP PartnersOICHP Partners Ottawa HospitalOttawa Hospital University of OttawaUniversity of Ottawa Royal Ottawa HospitalRoyal Ottawa Hospital Community Care Access Community Care Access

CentreCentre Community Health CentresCommunity Health Centres The MissionThe Mission The Salvation ArmyThe Salvation Army Fee for Service PhysiciansFee for Service Physicians ACT TeamsACT Teams Homes for Special CareHomes for Special Care City of Ottawa People City of Ottawa People

ServicesServices VolunteersVolunteers

Anglican Social ServicesAnglican Social Services CornerstoneCornerstone Shepherds of Good HopeShepherds of Good Hope Canadian Mental Health Canadian Mental Health

AssociationAssociation Wabano Centre for Wabano Centre for

Aboriginal HealthAboriginal Health Centre for Addiction and Centre for Addiction and

Mental HealthMental Health VON OttawaVON Ottawa Youth Service BureauYouth Service Bureau Bruce HouseBruce House Ottawa PoliceOttawa Police

GovernanceGovernance

Mission Board of Mission Board of DirectorsDirectors

ICHP Board of ICHP Board of Directors Directors

LiabilityLiability

Each group takes lead on area for Each group takes lead on area for which they are primarily responsible which they are primarily responsible (i.e. Mission Housing, ICHP health (i.e. Mission Housing, ICHP health care etc)care etc)

Details covered in a service Details covered in a service agreement which outlines who does agreement which outlines who does what what

Everyone has their own insuranceEveryone has their own insurance

The Mission Hospice 2001The Mission Hospice 2001The dream becomes a realityThe dream becomes a reality

StaffingStaffing Client care workers Client care workers

24/724/7 Palliative Care Nurse Palliative Care Nurse

16/ 7 days per week16/ 7 days per week Shift Nursing nights Shift Nursing nights

through CCACthrough CCAC Pain and Symptom Pain and Symptom

Management Management ConsultantsConsultants

Doctor visits twice a Doctor visits twice a week + 24 hour on callweek + 24 hour on call

VolunteersVolunteers

0

5

10

15

20

25

Diabetes HIV/AIDS

Housed

Chronically Homless

Main Diagnosis of Hospice Main Diagnosis of Hospice PatientsPatients

0

2

4

6

8

10

12

N = 41

Palliative CareMain Diagnoses

Alcoholic Cirrhosis

Cancer

COPD

Congestive Heart Failure

HIV

Hep C

Other

Family TiesFamily Ties

Many patients are Many patients are estranged from familyestranged from family

At the end of life about 70% At the end of life about 70% reconnect with families reconnect with families (some with great difficulty)(some with great difficulty)

Street friends are a source Street friends are a source of great comfortof great comfort

Patients have a strong need Patients have a strong need to make staff part of their to make staff part of their identified familyidentified family

Hospital vs HospiceHospital vs Hospice Cost/Benefit Cost/Benefit

Low cost alternative to hospital bed Low cost alternative to hospital bed ($170 per day vs. $350-900 in hospital)($170 per day vs. $350-900 in hospital)

Makes more appropriate use of hospital Makes more appropriate use of hospital resourcesresources

Better quality of life for individuals and Better quality of life for individuals and familiesfamilies

Lengthening of life expectancy for many Lengthening of life expectancy for many clientsclients

Cost savings to health care system of Cost savings to health care system of $797,525 per year$797,525 per year

A Hospice Like No Other!A Hospice Like No Other!What we planned vs What What we planned vs What

we havewe have We expected to We expected to

create a place create a place where people where people would die with would die with dignitydignity

Instead, we Instead, we created a place created a place where people who where people who are dying can live are dying can live with dignity and with dignity and joy (often for a joy (often for a long, long, long long, long, long time)time)

Unexpected outcomesUnexpected outcomes We expected short We expected short

stay admission for stay admission for terminal conditionsterminal conditions

But we got admissions But we got admissions of those who have of those who have complex needs, those complex needs, those who are frail and who are frail and vulnerable people vulnerable people from general shelter from general shelter and those struggling and those struggling in housing with no in housing with no other alternate other alternate housing or care housing or care options identifiable options identifiable in in additionaddition to the “pure” to the “pure” terminal conditionsterminal conditions

Unexpected outcomesUnexpected outcomes

We wanted to We wanted to provide care provide care limited to limited to addressing acute addressing acute medical or medical or mental health mental health concerns related concerns related to death and to death and dyingdying

We are trying to We are trying to address complex address complex social, legal, social, legal, family, short and family, short and long term issues long term issues which contribute which contribute to homelessness to homelessness in addition to in addition to palliative carepalliative care

OutcomesOutcomes

We agreed to We agreed to have a Harm have a Harm reduction reduction approach which approach which tolerated tolerated substance usesubstance use

We use a Harm We use a Harm reduction reduction approach which approach which tries to engage tries to engage the patients in the patients in better managing better managing substance usesubstance use

OutcomesOutcomes

We thought we We thought we would use a would use a palliative care palliative care modelmodel

We use Palliative We use Palliative Care and Cure Care and Cure Model , often at Model , often at the same time!the same time!

OutcomesOutcomes

Our mandate was Our mandate was service to service to individual clientsindividual clients

Our mandate has Our mandate has a greater focus a greater focus on creating on creating supportive supportive community, community, including family including family members and the members and the homeless homeless communitycommunity

OutcomesOutcomes

We planned for We planned for 100% of patients 100% of patients to dieto die

But, . . as many But, . . as many patients patients admitted for admitted for palliative care palliative care get better for a get better for a timetime

OutcomesOutcomes

We thought we We thought we wouldn’t need wouldn’t need links to housinglinks to housing

Need to create Need to create more links to more links to housing and housing and mechanisms for mechanisms for longer periods of longer periods of supportsupport

OutcomesOutcomes

We planned for 1 We planned for 1 space for womenspace for women

We’re dealing We’re dealing with increasing with increasing demand for demand for services to services to womenwomen

OutcomesOutcomes

We planned to We planned to have a program have a program with very little with very little staff run mostly by staff run mostly by volunteersvolunteers

We have been We have been fortunate to have fortunate to have attracted a large attracted a large component of component of highly qualified highly qualified staff but would like staff but would like to incorporate more to incorporate more volunteer resources volunteer resources into our programs into our programs in the futurein the future

Last ThoughtsLast Thoughts

We have a hospice that presents an We have a hospice that presents an alternative for those on the streets. In the alternative for those on the streets. In the last six years, more than 90 people have died last six years, more than 90 people have died in our hospice, most of them were pain free in our hospice, most of them were pain free at the end. This year we received ongoing at the end. This year we received ongoing funding from the Ministry of Health (for funding from the Ministry of Health (for staff). The remainder of the program is staff). The remainder of the program is generously funded by donations. We are generously funded by donations. We are truly blessed. truly blessed.

Diane Morrison Diane Morrison

For a copy of Diane’s presentation For a copy of Diane’s presentation please contact Pat Martin at the please contact Pat Martin at the Ottawa Mission.Ottawa Mission.

pmartin@ottawamission.compmartin@ottawamission.com