PEACH – Palliative Education and Care for the Homeless

The PEACH (Palliative Education and Care for the Homeless) Program 

 

PEACH is a supportive palliative service fostered by Inner City Health Associates (ICHA).  Aimed to meet the needs of people with life-limiting illnesses experiencing homelessness or vulnerable housing, PEACH’s focus lies with the pain, symptoms and psycho-social goals related to each and every client’s end-of-life journey. PEACH operates as a “trailblazing” mobile unit, providing attentive care in the community, on the streets and in shelters. The program functions as a partnership between ICHA, Toronto Central Home and Community Care Support Services, and Kensington Health.  

 

Goals and Objectives 

  • To provide quality early, integrated, and trauma-informed palliative care for the homeless and vulnerably housed populations with a focus on prioritizing dignity for all
  • To support and be a resource to primary team members in:
  •          providing end of life care
  •         managing basic and complex symptoms
  •         accessing medications on the PCFA
  •         ongoing support for patients followed by the service
  •         assistance in the navigation of palliative care resources
  • To educate and support mainstream palliative care services in Toronto to work effectively with structurally vulnerable populations
  • To increase competency of community homeless agencies to support clients facing end of life
  • To advocate for accessible, high quality, early, integrated palliative care for homeless and vulnerably housed populations
  • To advance the body of knowledge for delivery of palliative care for homeless and vulnerably housed patients

Our Team 

  • Celina Dycke, PEACH Health Navigator (Kensington Health)
  • Jan Dungog, Interim PEACH Nurse Coordinator 
  • Stephanie Sanders, PEACH Home Care Coordinator (Toronto Central Home & Community Support Services)
  • Naheed Dosani, PEACH Lead and Palliative Care Physician 
  • Alissa Tedesco, PEACH Deputy Lead, Education Lead and Palliative Care Physician
  • Donna Spaner, PEACH QI Lead and Palliative Care Physician
  • Trevor Morey, PEACH Research Lead and Palliative Care Physician
  • Humaira Saeed, PEACH Palliative Care Physician
  • Nicole Buchanan, PEACH Palliative Care Physician
  • Dan Rosenbaum, PEACH Psychiatrist

Referral Criteria 

Please complete the referral form here.

  • Homeless or vulnerably housed
  • Life-threatening illness
  • Significant pain and/or symptomatic burden
  • Difficulty accessing mainstream palliative care services

We serve the city of Toronto and aim to be low barrier. We accept referrals from any community care providers (i.e.: healthcare, social service workers). We will see patients without OHIP at no cost. For more information on the PEACH program, please email the PEACH Team’s Health Navigator or the PEACH Lead at 

Education 

The PEACH program offers a clinical rotation for medical trainees of all stages, entitled “Palliative Care in the Inner City: Integrating Social Accountability and Clinical Care for Structurally Vulnerable Populations.”  

In this elective, learners will gain a better understanding of the barriers faced by structurally vulnerable populations in the palliative care context, and how to work towards achieving equity in palliative care provision at micro, meso and macro levels. This will be accomplished through clinical experiences providing outreach visits with PEACH physicians, health navigators and coordinators, as well as interprofessional staff (health and social services). Clinical experiences will also be complemented by the completion of a written reflective exercise to deepen the learner’s knowledge of concepts and themes introduced through the rotation. Rotations must be for a minimum of 3 weeks in duration. This elective is available to medical students, residents and fellows. Please email to book. Please note there is currently limited availability for the 2023-2024 academic year. 

 Quality Improvement & Research  

Quality Improvement is an important part of the PEACH program as we strive to provide the highest quality of care and support to clients on the program. If you are interested in conducting QI work with the PEACH team, please email QI Lead Dr. Donna Spaner at . PEACH also conducts research aimed at improving palliative care quality and access to structurally vulnerable populations. See below for a list of PEACH publications. If you are interested in conducting work with the PEACH team, please email our research lead, Dr. Trevor Morey at .  

Publications  

Palliative Education and Care for the Homeless (PEACH): A Model of Outreach Palliative Care for Structurally Vulnerable Populations 

Exploring the Barriers and Facilitators Experienced by Palliative Health Care Providers Working with Patients Experiencing Homelessness during the COVID-19 Pandemic 

Assessing the impact of a health navigator on improving access to care and addressing the social needs of palliative care patients experiencing homelessness: A service evaluation.  

Palliative care for people who use drugs during communicable disease epidemics and pandemics: A scoping review on access, policies and programs and guidelines.  

Palliative Medicine: A Case Based Manual. Chapter 30: Palliative care for structurally vulnerable populations. 

Palliative care for people who use substances during communicable disease epidemics and pandemics: a scoping review.  

Retrospective study of a Toronto-based palliative care program for individuals experiencing homelessness. 

The Good Wishes Project: An end-of-life intervention for individuals experiencing homelessness.  

 

Caregiving at the margins: An ethnographic exploration of family caregivers experiences providing care for structurally vulnerable populations at the end-of-life.

COVID-19 and people experiencing homelessness: challenges and mitigation strategies. 

Providing data-driven equitable palliative and end-of-life care for structurally vulnerable populations: A pilot survey of information management strategies. 

Palliative care for homeless patients: A practical approach for medical students. ‘ 

Palliative care in the twenty-first century: Using advanced analytics to unlock insights from big data. 

“Just too busy living in the moment and surviving”: barriers to accessing health care for structurally vulnerable populations at end-of-life.  

Hospitals, clinics and palliative care units: Place-based experiences of formal healthcare settings by people experiencing structural vulnerability at the end-of-life. 

Palliative care as a public health issue: Understanding disparities in access to palliative care for the homeless population living in Toronto, based on a policy analysis. 

Advance care planning and end-of-life care interventions for homeless people: A systematic review. 

The right to accessible healthcare: Bringing palliative services to Toronto’s homeless and vulnerably housed. 

Minding the gap: access to palliative care and the homeless 

 

PEACH in the Media 

June 30, 2023

Toronto Shelter Network Grief & Loss Program Report

August 8, 2022 

‘Dying with dignity:’ Mobile team brings palliative health care to those experiencing homelessness 

August 8, 2021 

Dr. Naheed Dosani started PEACH to provide palliative care for homeless and vulnerably housed populations 

July 14, 2021 

Trailblazing a Path to Quality Care: Canada’s Supportive Palliative Service for the Unhoused – Coalition to Transform Advanced Care (CTAC) 

November 28, 2020 

Toronto palliative care team sees caseload double since start of COVID-19 
 

Toronto palliative patients on homeless spectrum confront new challenges due to COVID-19 
 

Video: Patient roster doubles for Toronto palliative care team amid coronavirus pandemic 

November 24, 2020 

Naheed Dosani, M.D.: Expand Palliative Care for the Homeless  

December 24, 2019 

Good Wishes grants gifts to the homeless 

March 8, 2019 

Palliative care team helps the homeless die ‘with dignity,’ a healing circle helps them grieve 

Oct 4, 2018 

Last Rights – Megaphone Magazine 

Feb 20, 2018 

Dr. Naheed Dosani receives Meritorious Service Cross Governor General Award 

Governor General to Present Honours to “trailblazer” Dr. Naheed Dosani 

June 8, 2017 

CBC Superior Morning: Homeless & Sick 

January 21, 2017 

CBC The National: Delivering care to Toronto’s homeless 

January 17, 2017 

CBC News: Doctor hits the road to deliver palliative care to Toronto’s homeless 

CBC News Morning Live: Palliative Care for Toronto’s Homeless 

CBC News: Doctor hits the road to deliver palliative care to Toronto’s homeless 

January 5, 2017 

USA TODAY: Mobile team offers comfort care to homeless at life’s end 

July 22, 2016 

Homeless Hub Blog Post: How do people experiencing homelessness get palliative care? 

May 9, 2016 

TEDXxStoufville: Naheed Dosani, What’s a Life Worth? 

May 6, 2016 

Nurse Helps Homeless Die with Dignity 

March 5, 2016 

‘What is a life worth?’: Doctor passionate about palliative care for the homeless 

October 29, 2015 

A PORT in the Storm 

April 5, 2015 

CBC Radio, Tapestry: What’s a life worth? 

February 18, 2015 

Juxtaposition Magazine: PEACH program provides compassionate palliative care for city’s homeless 

August 13, 2014 

Global News: Interview with Dr. Naheed Dosani 

August 7, 2014 

Radio Canada International: Palliative care doctors working to aid homeless 

August 4, 2014 

CTV News: Palliative care for the homeless: Mobile program brings comfort and treatment 

August 3, 2014 

Global News: PEACH program provides mobile palliative care for Toronto’s homeless 

City News Toronto: Dying homeless find treatment, comfort through mobile palliative care program 

CTV News: Mobile palliative programs give “end-of-life care” to homeless 

Toronto Star: Palliative care program helps homeless in their final days