A Hospice Like No Other!

1. A Hospice Like No Other!

2. 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 • addictions • 2. mental illness • 3. their chosen lifestyle • Requests from clients to avoid hospital use

3. 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 Make the cause and the dream public Get on the public health agenda for the city of Ottawa

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

5. Keep the focus on the people that need the service

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

7. The Ottawa Model • 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

8. Model of Service Delivery • 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)

9. Ottawa Hospital University of Ottawa Royal Ottawa Hospital Community Care Access Centre Community Health Centres The Mission The Salvation Army Fee for Service Physicians ACT Teams Homes for Special Care City of Ottawa People Services 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 OICHP Partners

10. Governance • Mission Board of Directors • ICHP Board of Directors

11. Liability • 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 • Everyone has their own insurance

12. The Mission Hospice 2001The dream becomes a reality

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

15. Main Diagnosis of Hospice Patients

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

17. Hospital vs Hospice Cost/Benefit • Low cost alternative to hospital bed ($170 per day vs. $350-900 in hospital) • Makes more appropriate use of hospital resources • Better quality of life for individuals and families • Lengthening of life expectancy for many clients • Cost savings to health care system of $797,525 per year

18. 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) A Hospice Like No Other!What we planned vs What we have

19. 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

20. 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 Unexpected outcomes

21. 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

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

23. 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

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

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

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

27. 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 Outcomes

28. 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. Diane Morrison

29. For a copy of Diane’s presentation please contact Pat Martin at the Ottawa Mission. • pmartin@ottawamission.com