A Hospice Like No Other!

Build the case Homeless people were dying on the streets, in shelters and in substandard housing. Barriers to mainstream palliative care services for the homeless population were 1.addictions 2. mental illness 3. their chosen lifestyle Requests from clients to avoid hospital use

Gather Public Support Find champions in the health care system – public health street nurses, local community health centres and representatives from the mainstream health care system Obtain the support of the “mainstream” Palliative Care Community Obtain the support of the “mainstream” Palliative Care Community Make the cause and the dream public Get on the public health agenda for the city of Ottawa

Develop a Vision Recognized need to change how the homeless community deals with death and dying Recognized need to change how the homeless community deals with death and dying Need for a facility which embraces “street culture” Need for a facility which embraces “street culture” Need to integrate services for the homeless with mainstream palliative care Need to integrate services for the homeless with mainstream palliative care

Keep the focus on the people that need the service

Build the Model The Mission Hospice can Provide housing for those who have none Provide housing for those who have none Be flexible, not many rules or regulations to follow Be flexible, not many rules or regulations to follow Allow clients to retain lifestyle and remain part of their community Allow clients to retain lifestyle and remain part of their community Support a focus on living - not on dying Support a focus on living - not on dying

The Ottawa Model Ottawa Inner City Health Project Ottawa Inner City Health Project Superior health service to the homeless population Supported by all the shelters in the city Services offered palliative care, managed alcohol, convalescent care Incredible partnerships

Model of Service Delivery Based on partnership between many organizations Based on partnership between many organizations Based on committed ongoing relationship between Mission (housing, food, spiritual care, transportation, etc) and Ottawa Inner City Health (health care) Based on committed ongoing relationship between Mission (housing, food, spiritual care, transportation, etc) and Ottawa Inner City Health (health care)

OICHP Partners Ottawa Hospital Ottawa Hospital University of Ottawa University of Ottawa Royal Ottawa Hospital Royal Ottawa Hospital Community Care Access Centre Community Care Access Centre Community Health Centres Community Health Centres The Mission The Mission The Salvation Army The Salvation Army Fee for Service Physicians Fee for Service Physicians ACT Teams ACT Teams Homes for Special Care Homes for Special Care City of Ottawa People Services City of Ottawa People Services Volunteers Volunteers Anglican Social Services Cornerstone Shepherds of Good Hope Canadian Mental Health Association Wabano Centre for Aboriginal Health Centre for Addiction and Mental Health VON Ottawa Youth Service Bureau Bruce House Ottawa Police

Governance Mission Board of Directors Mission Board of Directors ICHP Board of Directors ICHP Board of Directors

Liability Each group takes lead on area for which they are primarily responsible (i.e. Mission Housing, ICHP health care etc) Each group takes lead on area for which they are primarily responsible (i.e. Mission Housing, ICHP health care etc) Details covered in a service agreement which outlines who does what Details covered in a service agreement which outlines who does what Everyone has their own insurance Everyone has their own insurance

The Mission Hospice 2001 The dream becomes a reality

Staffing Client care workers 24/7 Client care workers 24/7 Palliative Care Nurse 16/ 7 days per week Palliative Care Nurse 16/ 7 days per week Shift Nursing nights through CCAC Shift Nursing nights through CCAC Pain and Symptom Management Consultants Pain and Symptom Management Consultants Doctor visits twice a week + 24 hour on call Doctor visits twice a week + 24 hour on call Volunteers Volunteers

Main Diagnosis of Hospice Patients

Family Ties Many patients are estranged from family Many patients are estranged from family At the end of life about 70% reconnect with families (some with great difficulty) At the end of life about 70% reconnect with families (some with great difficulty) Street friends are a source of great comfort Street friends are a source of great comfort Patients have a strong need to make staff part of their identified family Patients have a strong need to make staff part of their identified family

Hospital vs Hospice Cost/Benefit Low cost alternative to hospital bed ($170 per day vs. $ in hospital) Low cost alternative to hospital bed ($170 per day vs. $ in hospital) Makes more appropriate use of hospital resources Makes more appropriate use of hospital resources Better quality of life for individuals and families Better quality of life for individuals and families Lengthening of life expectancy for many clients Lengthening of life expectancy for many clients Cost savings to health care system of $797,525 per year Cost savings to health care system of $797,525 per year

A Hospice Like No Other! What we planned vs What we have We expected to create a place where people would die with dignity We expected to create a place where people would die with dignity Instead, we created a place where people who are dying can live with dignity and joy (often for a long, long, long time)

Unexpected outcomes We expected short stay admission for terminal conditions We expected short stay admission for terminal conditions But we got admissions of those who have complex needs, those who are frail and vulnerable people from general shelter and those struggling in housing with no other alternate housing or care options identifiable in addition to the “pure” terminal conditions

Unexpected outcomes We wanted to provide care limited to addressing acute medical or mental health concerns related to death and dying We wanted to provide care limited to addressing acute medical or mental health concerns related to death and dying We are trying to address complex social, legal, family, short and long term issues which contribute to homelessness in addition to palliative care

Outcomes We agreed to have a Harm reduction approach which tolerated substance use We agreed to have a Harm reduction approach which tolerated substance use We use a Harm reduction approach which tries to engage the patients in better managing substance use

Outcomes We thought we would use a palliative care model We thought we would use a palliative care model We use Palliative Care and Cure Model, often at the same time!

Outcomes Our mandate was service to individual clients Our mandate was service to individual clients Our mandate has a greater focus on creating supportive community, including family members and the homeless community

Outcomes We planned for 100% of patients to die We planned for 100% of patients to die But,.. as many patients admitted for palliative care get better for a time

Outcomes We thought we wouldn’t need links to housing We thought we wouldn’t need links to housing Need to create more links to housing and mechanisms for longer periods of support

Outcomes We planned for 1 space for women We planned for 1 space for women We’re dealing with increasing demand for services to women

Outcomes We planned to have a program with very little staff run mostly by volunteers We planned to have a program with very little staff run mostly by volunteers We have been fortunate to have attracted a large component of highly qualified staff but would like to incorporate more volunteer resources into our programs in the future

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

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