"We're actually challenging the definition of hospice care": Policies and practices in hospice palliative care for older people experiencing homelessness

Walsh, J. J., Sussman, T., & Canham, S. L. (2026, Oct). "We're actually challenging the definition of hospice care": Policies and practices in hospice palliative care for older people experiencing homelessness [poster presentation]. Montreal International Palliative Care Conference 2026, Montreal QC, Oct 6 - 9, 2026.

Abstract

Older people experiencing homelessness (OPEH) are often excluded from competent palliative care. While there is a small but growing network of Canadian programs aimed at supporting the end-of-life care needs of OPEH, little is known about the unique needs, practices, and innovations required to improve the delivery of competent and inclusive palliative care services to the growing number of OPEH who will require such support.  To address this gap, we conducted a content analysis of 75 Canadian palliative care and homelessness policy documents, and a case study exploring practices through qualitative interviews, organizational surveys, policy document reviews, and site visits at seven hospices with mandates to care for OPEH. Our findings affirm the invisibility of end-of-life care in Canadian policy frameworks in the homelessness sector, identify the unique end-of-life and bereavement needs of OPEH, and illuminate how practices shape hospice spaces to create a sense of belonging at end-of-life. Hospice workers identified four prevalent and intersecting needs among OPEH requiring end-of-life care: mistrust and trauma, substance use, strained social supports, and precarious social circumstances. These hospices used relational (e.g. trauma-informed practice), community-building (e.g. collaboration), and equity-oriented practices (e.g. Indigenous cultural inclusion) to respond to these needs. Together, these practices shaped the build environment- such as smoking patios and access to Indigenous medicines - which created inclusive spaces for a population typically excluded from palliative care. This presentation will include recommendations to expand the scope and breadth of policy, programs, and practice in this critical area.