International Nurses Day 2020: Case study of the week

International Human Solidarity Day: Palliative Outreach for those who are homeless and living in poverty, Canada

Contributors: Kelli Stajduhar & Sally Thorne

International Human Solidarity Day, celebrated on 20 December, is a day to encourage debate on the ways to promote solidarity for the achievement of the Sustainable Development Goals including poverty eradication; and a day of action to encourage new initiatives for poverty eradication. Here, we present a case study on a nursing initiative to provide palliative care for those who are homeless and living in poverty.

Kelli Stajduhar has worked in palliative care for 30 years in Victoria, British Columbia, Canada. A PhD-prepared Clinical Nurse Specialist with a passion for high quality end-of-life care and health equity, she is someone who likes to get things done.

Through her research, collaborations and community partnerships over many years, Kelli has created a widespread understanding of how a “palliative approach” to care – an approach focusing on that person’s own goals and priorities rather than managing their disease – can dramatically improve our ability to provide relevant and meaningful care to people with chronic and potentially life-limiting illness. Building upon that deep expertise, in recent years Kelli has made major inroads in developing and implementing creative new ways to provide good end-of-life care to some of the most vulnerable members of Canadian society – those who are living in extreme poverty at the end-of-life. In every society, there are people who face structural inequities such that they are disadvantaged in receiving health and social care, including care at the end of their life.

For the last several years, Kelli has been leading an interdisciplinary academic and community collaborative research project entitled Equity in Palliative Approaches to Care. That research has shown how homeless and barely housed people face the challenge of navigating many complex systems, including housing, social care and health care. Kelli’s approach is to do community-based research to get services to these people where they are and in ways that work for them. As their health declines due to life-limiting conditions such as heart failure, lung disease or cancer, the ability of homeless persons to access any of these systems of support also inevitably declines. However, if they are able to access some form of palliative care services, Kelli’s team showed that these individuals could actually experience a real improvement in their quality of life, even with these chronic conditions.

On the basis of the insights that have emerged from the research findings of Kelli’s team, several health authorities and community groups have now come together to fund what they are calling a Palliative Outreach Resource Team (PORT). This is a service to which people can self-refer or be referred by their caregivers, including their chosen or “street” family, or by shelter staff, peer or support workers. It includes advance care planning with drug users, multiple outreach activities with housing workers and peers to integrate palliative approaches to care into their everyday work, and they have recently launched a mobile palliative care service the inner city of Victoria. As Kelli says “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. This approach necessitates a community response where everyone sees their responsibility and their part in care for the dying.”

Like so many strategies to make a difference when it comes to highly complex problems, delivering meaningful and appropriate palliative care to homeless and barely housed persons requires an extensive network of professionals, partner organisations and community leaders. It is truly a team effort, grounded in an abiding commitment to care, to equity and to a better world for all of society’s members. But without the strong leadership that comes from a nursing perspective on matters of how health and public policy intersect, this kind of initiative might never have been envisioned. Kelli Stajduhar‘s work is truly an exemplar of excellent nursing in action.

Photo Credit: University of Victoria Media Services