New palliative care program provides end-of-life support for Victorians living in poverty
Dr. Fraser Black of PORT meets with a patient in Victoria: (Photo courtesy of UVic)
Death may be the great equalizer, but for people who are destitute getting access to quality end-of-life care may leave them feeling far from equal.
To bridge that gap, a new mobile palliative care program, Palliative Outreach Resource Team (PORT), is providing care and dignity to people with life-limiting illnesses who are living in poverty in Victoria.
PORT is a pilot program that connects people with serious illnesses with caregivers, palliative care and other health and social support systems.
"People have been asking us to see people in their cars, in tents, places where it is just really hard to survive each day," said PORT physician Dr. Fraser Black.
"What PORT really strives to do is to meet the person where they are to address not only the physical needs that the person may have as they are nearing death, but also their psycho-social and their spiritual needs."
The program is built upon lessons learned from a three year study led by University of Victoria palliative care researcher Kelli Stajduhar. The study followed 25 people who were homeless or barely housed while struggling with life-threatening medical conditions.
The 2018 report found that homeless and barely housed people faced many barriers when seeking end-of-life care. For people who are dying and living in poverty, the ability to access services — such as health care — decline as their health declines.
In contrast, the study found those who were able to access palliative care actually experienced an improvement to their quality of life.
“Palliative care isn’t a thing or a place but an approach that focuses on whole-person care for the person, their family and community," said Stajduhar.
"This approach necessitates a community response where everyone sees their responsibility and their part in care for the dying.”
The PORT program is designed so that people who are dying can self-refer or be referred by their caregivers to a palliative care nurse and physician. The health care workers then connect patients with people who are able to provide whole-person care, which helps patients manage their pain and symptoms related to life-limiting illness.
The program will also connect professionals with patients' families and caregivers to provide grief and bereavement support. For many people living in poverty, their chosen family and caregivers may include their “street family”, their housing or harm reduction supporters and other support workers who tend to perform the bulk of end-of-life care.
"It can be scary for the patient, for the individual that is dying," said Black.
"Sometimes people are worried in silence about what their death might look like. We have conversations with them about where they would be the most comfortable as they are nearing the end of their life and when they are dying."
The PORT team, which began servicing the island in July, has supported three deaths and is currently supporting seven people who are dying.
The program is a collaboration of the University of Victoria, Island Health, the Victoria Cool Aid society and Victoria Hospice.