1. End of Life Care With People Experiencing Homelessness Abe Oudshoorn, RN, PhD Assistant Professor, School of Nursing, Western University

2. Where are the homeless? 2

3. Who are the Homeless? 66% mental health challenges 33% addictions But, causes of homelessness are as many as the number of people experiencing homelessness 3

4. How many are homeless? 4

5. Why are they Homeless? 5

6. How is their health? 6

7. LHSC Emergency St Joseph’s Urgent Care Health Zone CMHA – Access Team CCAC London Crisis Pregnancy Centre Youth Action Centre Middlesex London Health Unit At’ Lhosa Regional HIV/AIDS Connection London Public Library Addiction Services of Thames Valley EMS Men’s Mission Street Scape Centre of Hope Withdrawal Management Chiropractors@COH Centre of Hope Family Health Team Women’s Community House DOCS – Dental Outreach Bethesda Centre EMDC LHSC Women’s Health St Leonard’s My sister’s Place Salvation Army- Mobilizing Hope Pharmacies Methadone Clinics LIHC Quinton Warner Wotch SOAHC Regional Support Associates Infectious Disease Care John Gordon Home Dale Brain Injury Service CAS RMHC What health care do they access?

8. Is their health care appropriate? ED Walk-in clinic CHC Home care? 8

9. What is this costing us? 9

10. Behavioural Barriers? Or policy barriers? 10

11. What constitutes ‘palliative’? “life-threatening illness”, “serious illness” 11

12. Pain and addiction 12

13. Treatment solutions People, most often, will die how they lived. Harm reduction Mental health support Behavioural considerations 13

14. Structural Solutions Medical respite – Shelter based? – Hospital based? – Hospice based? – Stand alone? – CHC based? 14

15. Functional Example 15

16. Questions 16