The tent city on the B.C. courthouse lawn has shown us once again how hard it is to live on the streets. Poverty makes daily life dangerous and unhealthy. Systemic roadblocks, from poverty and racism to the stigma of mental-health issues and the criminalization of addiction, obstruct possible escape routes out of homelessness.
Donald Peter Prevost’s story tells us even more about the precariousness of life as a homeless person in our community. Prevost is the man in our community who was discharged from Victoria General Hospital this month with nowhere to recover from surgery except on a shelter mat or on the street after doctors removed his gallbladder. He also suffers from severe arthritis and other disabilities. Even if a shelter bed could have been found, staff would not be equipped to ensure Prevost’s healing.
Death looms close for homeless Victorians. While life expectancy for British Columbians averages between 80 and 84 years, homeless people die at a median age of only 40 to 49. Between 2007 and 2013, Victoria had the highest per-capita number of deaths of homeless people in B.C. At least 10 aboriginal people have died on the street here already this year, according to outreach worker Bernice Kamano.
Death can come in an alley, a shelter or a car. A big fear, not surprisingly, is of dying anonymously or undiscovered.
Still, homeless people are survivors. They must be to keep going when they have nowhere to sleep, nothing to eat and face discrimination at every turn. Dealing with chronic illnesses and isolation means good health is rarely attainable, yet homeless people feel unworthy of care; biases, both societal and from health workers, tell homeless people that they are undeserving.
Shelter staff who are well-equipped to work with this population can’t always recognize a dying person. Someone with advanced lung cancer who comes to a shelter for the night would not necessarily look or sound different than any other client to a medically untrained eye.
The final injustice for homeless people is to have no palliative or end-of-life care available. If you or I want to register for hospice care, we provide a home address where we can receive an assessment. We get a referral from a doctor, oncologist or health-care provider who knows we have a progressive, life-threatening illness. A homeless person has no address and rarely has access to a professional to provide a diagnosis or transportation to appointments.
The University of Victoria and the Palliative Outreach Resource Team are looking at what happens when a health-care system designed for “average” people meets those with multiple barriers to health care as they near death. The three-year study launched in 2014 is working to identify these barriers to inform targeted interventions and equitable health services and policies for end-of-life care.
One Victoria man, who slept in a shelter, explained to researchers how he tried to get help for severe back pain. He was labelled as “drug-seeking” because of previous illicit drug use and homelessness and was refused. In worsening pain, he went to emergency and refused to leave. He was finally seen and was diagnosed with terminal cancer. But the diagnosis of an incurable disease still doesn’t unlock the gates to timely, appropriate end-of-life care for homeless people.
PORT brings together members of the Victoria Cool Aid Society, AIDS Vancouver Island, Victoria Hospice, Our Place and the Dandelion Society to improve quality and access to palliative and bereavement services for dying homeless people. They work to bridge the rigid institutional silos in our health-care system that prevent the co-ordination of services that homeless people need and deserve.
But PORT has no funding. And, typical for hospices across Canada, Victoria’s hospice receives only half of its modest ($8-million) budget from taxpayers, relying on donations for most of the rest.
Let’s act sensibly and humanely and ask our provincial government to fund and work with health-care agencies to provide an equitable approach to palliative care, including those who can’t die at home because they have no home in which to live.
Dr. Kelli Stajduhar and Ashley Mollison are members of an academic and community partnership between the Institute on Aging and Lifelong Health at the University of Victoria and the Palliative Outreach Resource Team in Victoria. For more information about their study, see uvic.ca/peol.