ICHA - PEACH – Palliative Education and Care for the Homeless

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 Health at Home, 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)
Rachel Birmingham, PEACH Virtual 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
Jill Chettiar, PEACH Palliative Care Physician
Dan Rosenbaum, PEACH Psychiatrist
Trish Flannagan, PEACH Clinical Coach

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 2024-2025 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.