Palliative Care Nurse to the Homeless

By ALEX NEWMANLiving

Fri., May 6, 2016

A homeless man, dying of cancer, asked to be allowed to finish his days in the place he called home — the shelter he’d stayed in for several years. After all, dying at home is the wish expressed by 90 per cent of Canadians, according to studies.

Most of us, in the right circumstances, could be granted that. But for the homeless, it’s not been possible. At least, not until now.

Thanks to a new program — Palliative Education and Care for the Homeless (PEACH) — the homeless man was quickly secured a spot in a palliative care unit, and then just as quickly brought back to the shelter.

“He was so grateful to be back where he considered home, he was able to sleep more comfortably that night. He died a few weeks later,” recalls Namarig Ahmed, the community nurse co-ordinator for PEACH, who garnered an honourable mention in the 2016 Toronto Star’s Nightingale Awards for her compassion to this vulnerable population.

As she points out, “The homeless get sick, too, and they die just like the rest of us … and our goal is let them die wherever they call home, if possible. For most of them, that would be the shelter they spend their nights in.”

Shelters, however, have restrictions, such as the need for everyone to leave during the day for cleaning — not ideal for someone too ill to get out of bed. As well, shelters do not admit outsiders after dark, including medical staff.

The answer doesn’t lie in the hospitals, either, since many homeless are on harm reduction programs (drugs or alcohol administered in controlled amounts).

Ahmed has been a nurse for seven years, and she went into nursing because she loved working with people. It never crossed her mind to work with the homeless, though. She’d been a nurse with Inner City Health Associates (ICHA), an organization with roughly 60 family doctors and psychiatrists who provide care through shelters and drop-ins to those experiencing homelessness.

A few years ago, ICHA staff recognized the need for palliative care for this population and began conversations with Community Care Access Centre (CCAC) about how that might look.

Ahmed was asked if she would co-ordinate the program. She said no. “I didn’t think I had the emotional or mental capacity to deal with the level of loss those experiencing homelessness have endured, and provide the support they need … all the barriers they face in their lives … who they tried to be and who they couldn’t be.”

That changed after she agreed to try it out for awhile. “The work is in its own way deep and beautiful … humbling, inspiring … I’ve learned from them how to be more human … both as a nurse and as a person. We’re all the same, wanting the same thing, having the same ability to love and be loved.”

Ahmed not only works with 20 to 25 clients at any given time, she also works with shelter staff, educating them about how to care for palliative patients. “It’s essentially comfort care. Not just for pain management, or shortness of breath and nausea, but also psychosocial comfort and support from anxiety and depression … social isolation.”

But the homeless are not entirely alone, Ahmed points out. They have a community among the other shelter residents, who “provide a different level of support and feeling of home,” and they have the shelter workers, who Ahmed says “give so much, and care so well for these people.”

Providing palliative care to this population wouldn’t be possible, Ahmed says, without partners, including Hospice Toronto and CCAC. These two organizations provide nurses and volunteers to assist in tasks such as bathing and dressing, taking patients to medical appointments, and helping write letters to family and friends clients haven’t communicated with for years.

Co-ordinating the various services takes time and effort because of the overlapping issues — mental health, addiction, end-of-life, Ahmed says. “It’s important to know who the players are so you can get them the right help.”

Although the PEACH program is “one step closer to dying with dignity, and with as little pain or discomfort as possible, we’re still trying to find better way to deal with this,” Ahmed says. “Having conversations with other health-care providers is a vital first step to find a solution and make this care accessible to all.”

Sadly, though, the homeless population is growing. “The economy is skewed, and we now see different types of homeless in the shelters, including an elderly population unable to maintain living standards on Old Age Security. These are people likely needing palliative care at some point.”

Ahmed says the people she serves keep her determined to deliver the best care. “Sometimes, I go into a visit and prepare myself for it being emotionally taxing. Inevitably, I end up coming away inspired by their level of hope.”