01/28/18

End-Of-Life Care Is A New Beginning For Some Homeless Patients

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by Mariana Dale

Inside a medical care facility in central Phoenix there’s a small chapel with frosted glass windows.

On the wall there’s more than a dozen framed photos of smiling faces. These are the people who have passed on here; many were in the final stages of their life.

James Martz was diagnosed with lung cancer in 2017 and hit rock bottom before getting help at Circle the City.

“They all brought their gifts to this world and they ended up in a place where they had no one,” said Lin Sue Cooney, Hospice of the Valley Community Engagement director. “It’s our collective responsibility as a community to make sure that they have dignity and comfort at the end of life.”

The medical care center Circle the City has 50 beds to care for the homeless, and several are reserved for hospice patients. Medicaid can pay for end-of life-care and even those who can’t pay anything are still treated.

The number of homeless older Americans is rising.

The state’s largest emergency shelter, Central Arizona Shelter Services, known as CASS, saw 423 clients over age 62 last year.

CEO Lisa Glow said the oldest, 89, came into the shelter pushing a walker. Her son was taking her pension and she was homeless.

“There’s vulnerability to fraud, vulnerability to disease, vulnerability to abuse and being taken advantage of,” Glow said. She said there aren’t enough resources at CASS or in the Valley to handle the predicted influx of older people who will end up on the streets and in poor health.

“Being an emergency shelter, people have to take care of their basic daily living needs,” Glow said.

Jesus Tovar, 67, was discharged from the hospital to Circle the City.

Me sufre mucho en la calle, mucho frío, llueve, a veces no tienes que comer.” Tovar said he suffered a lot in the streets; it was cold, it rained and sometimes he didn’t have anything to eat. Tovar is diabetic and has problems with his lungs and heart.

His voice became thick with emotion when he talked about life on the street.

Aquí tienes cama. Te dan tus medicinas.” Here there’s a bed, they give you your medicine. It’s like another family, Tovar said. “Aquí tiene como otro familia.

Tovar is also working toward connecting with his own family through a social worker at the center.

Jesus Tovar said he became disconnected with his family when he lived on the streets. He hopes to mend their relationship with the help of a social worker at Circle the City.

“With that aging comes an inherent need for better end of life care and we have to be able to rise to that challenge,” said Brandon Clark, Circle the City CEO.

“When people come here on hospice they frequently have no one,” Clark said. “It’s rare they have no one when they leave this world.”

‘Pride almost killed me’

Almost everything James Martz is wearing from his UnderArmor sweatshirt to his tennis shoes is new, at least to him.

A chunky silver ring on his right hand is one of the only material possessions Martz still has from his “old life.” It represented his time as a member of the North American Hunting Club.

“Pride almost killed me.” Martz said it’s what kept him from asking for help earlier.

Martz can list the events that lead to rock bottom — drug use, an eviction, a pneumonia diagnosis that revealed lung cancer, chemotherapy.

“It would make me throw up, the other thing,” Martz said grimacing. “You didn’t want to eat. You wanted to sleep all the time.”

In September, Martz said his oncologist gave him six to nine months to live. 

Around that time he was sleeping in his broken down 1993 Oldsmobile Cutlass in a strip mall parking lot in Mesa. Eventually police kicked him out after the center’s owner complained.

“I just grabbed my meds and anything essential and just walked off the property,” Martz said. He walked until the skin on his feet bubbled into blisters. A hospital covered the wounds with salve and discharged him.

“I got out of the hospital and I tried to get out of the wheelchair they wheeled me in and I couldn’t even stand up,” Martz said. Then he remembered he had a number for Hospice of the Valley. 

“He was very sick, sad, uncertain of the future, some anxiety and I think he just didn’t know what was going to happen,” said Kim Despres, a program director at Circle the City where Martz ended up.

RELATED: KJZZ’s Special Series, Homeless In Plain Sight

Homeless people can recover there when they’re not sick enough to stay in a hospital, but not well enough to be on the streets.

It’s also one of the only places that provides end-of-life care for people who have nowhere else to go. James Martz had decided he was done with chemotherapy and entered hospice there.

Hospice of the Valley took care of 18,500 patients and family members last year. It’s just one of dozens of hospice organizations in the Valley.

Complete Article HERE!

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07/12/17

Homeless and Dying in America

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Facing the End of Life Alone

By Betty R. Ferrell, PhD, RN

As Homeless Persons Near the End of Life

Statistics about the US homeless population are staggering. More than a million people face homelessness each year in the United States, and these individuals often have multiple complex illnesses and comorbid mental health conditions. Orchestrating care for the homeless population poses significant challenges.

Little is known about the end-of-life (EOL) experiences of homeless persons. A major gap in knowledge exists regarding the symptoms experienced by homeless persons at or near the EOL—information that would help clinicians not only manage these symptoms but also assist homeless persons with advance care planning and decision-making around death and dying.

To characterize these symptoms, Tobey and colleagues[1] surveyed homeless persons at a medical respite program who were approaching the EOL. The demographic data derived from this study speak to the distinct palliative care needs of the homeless. Sociodemographic data from this study, showing that 60% had substance use disorders and 85% abused alcohol, will greatly affect the provision of care for this population. All homeless patients interviewed reported experiencing pain, and psychosocial needs were equally significant. Nearly all (95%) of the sample had experienced the death of a loved one, 25% worried daily about their own mortality, and 75% worried that no one would even know that they had died.

Viewpoint

The palliative care needs of various subgroups of people with serious illnesses are well documented in the literature, providing data about the unique physical and psychosocial needs of patients across many diagnoses and clinical settings.[2,3,4] The study by Tobey and colleagues adds to the body of literature by describing the distinct needs of the homeless population. The findings of this study provide insight for clinicians and for health policy administrators to attempt to meet the challenging needs of the homeless.

The study’s design was commendable. Direct interviews with homeless persons helped to understand their unique needs during their last months of life. The use of a medical respite center serving the homeless provided an ideal environment for the study.

Although the study sample size was small, the findings are rich in meaning and have implications far beyond the medical respite unit where the study was conducted. These findings will also apply to the many diverse settings where homeless persons seek care: public hospitals, emergency departments or urgent care centers, Veterans Affairs hospitals, and other settings.[5,6] Continued research and clinical advances in the care of the homeless are obligations of palliative care, a field committed to comfort and respect for all patients.

Complete Article HERE!

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08/19/16

Dying on the streets: UVic study examines palliative care for the homeless

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‘We were hearing all kinds of stories, and service providers themselves were feeling very distressed’

By Roshini Nair

UVic researcher Kelli Stajduhar says it's not atypical people living on the streets wind up spending their last days in places like cars or parks.

UVic researcher Kelli Stajduhar says it’s not atypical people living on the streets wind up spending their last days in places like cars or parks.

It’s an uncomfortable truth, but some people spend their last days in parks, streets and their cars, alone and in pain.

University of Victoria researcher Kelli Stajduhar has been leading a study looking at palliative care options for the homeless after hearing stories from outreach workers about people dying in the streets.

“We would really like to think as a society that we care for our people, especially at the end of their lives,” she said.

“[But] we were hearing all kinds of stories, and of course, these service providers themselves feeling very, very distressed at the kinds of things they were witnessing.”

Poor relationship to health care providers

Stajduhar — a palliative care nurse — is a strong advocate for better quality end-of-life care, and she said that people on the streets face significant barriers to getting care.

For one, they might not be diagnosed properly or too late.

Many homeless individuals come into the emergency room in pain but leave early or are turned away, she said.

Eventually they are diagnosed, but it is too late.

“They’re finally diagnosed with an illness that’s so far advanced even if a treatment option was offered, there’s really no benefit.”

Furthermore, Stajduhar said homeless individuals are often denied pain medication because health-care providers assume they’re just trying to access drugs.

These negative experiences with the health care system leave homeless people distrustful and unwilling to seek out care, she said.

“We’ve got these situations where people are suffering needlessly, and a big part of that is because of our own biases and stigmas against people.”

Staying within the community

Stajduhar said since many people on the streets are isolated and estranged from their loved ones. Often, the only community they know and love is the downtown community.

“We need to be seeing people and providing service to where they’re at, where they are most comfortable.”

Kelli Stajduhar, a professor of nursing at the University of Victoria, has been a palliative care nurse for three decades.

Kelli Stajduhar, a professor of nursing at the University of Victoria, has been a palliative care nurse for three decades.

But shelters and outreach workers are not equipped to provide palliative care, she said, and there is often no coordination between different groups to provide the best sort of end-of-life care.

Stajduhar said her team is looking at how palliative care providers can be flexible enough to meet people in the community.

One especially promising model is Toronto’s PEACH team — or the Palliative Education and Care for the Homeless team.

The PEACH team has outreach doctor, nurses, and social workers who see people wherever they happen to be — in shelters, on the streets or in a housing complex.

Stajduhar said she can imagine a similar model in Victoria, although there would need to be more funding.

“We have the nuts and bolts in our community to do that.”

Complete Article HERE!

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02/3/16

Government program funds funerals for B.C.’s deceased homeless

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By IAN BAILEY

Homeless in his last days, Joerg Brylla did not leave assets to pay for a lavish funeral and eternal place of rest.

homeless-1

But, today, Mr. Brylla’s ashes are behind a brass plate labelled with his name and lifespan – 1945-2014 – in a brick wall at a North Vancouver cemetery. There’s a forest setting and a nearby pond. The cost to inter Mr. Brylla, who died of natural causes in a protest camp over affordable housing in Vancouver’s Downtown Eastside, was covered by the B.C. government as a part of a program that addresses the fate of the homeless when they die.

The Vancouver funeral home that handles many government-funded funerals happened to have space in the North Vancouver cemetery where it sent the remains of 69-year-old Mr. Brylla, also known as Bunny George – the focus of a recent Globe and Mail investigation into his eventful life and tragic death.

The situation reflects the reality of attending to the remains of the homeless in British Columbia – not only funeral costs, but also the rites and traditions of gathering to pay tribute to people who die without addresses, and often without salient facts of their lives being known.

In Mr. Brylla’s case, the North Vancouver cemetery fit within the budget set by the Ministry of Social Development, said Corey Dixon, assistant manager of the Glenhaven Memorial Chapel on East Hastings. Mr. Dixon said he did not have a specific cost figure at hand. He said Glenhaven handles 270 to 300 such funerals each year.

The social-development ministry said it spent $3.2-million in the last fiscal year on 2,000 services as part of its funeral supplement program, which can involve the deaths of homeless people, as well as others lacking funds to cover costs.

In a written response to questions from The Globe, Charlotte Poncelet, the executive director of the British Columbia Funeral Association, said funding has not increased since 2008, so its members “frequently financially subsidize these services because they believe that a person’s financial means does not diminish the significance of their life.”

Many people buried under the program are sent to the Surrey Centre Cemetery, which is more affordable than elsewhere in the Vancouver region, although families can make their own recommendations. Outside the Lower Mainland, people are buried wherever space is available.

At the Surrey cemetery, labourer Matthew Scozzafava said there is no paperwork to designate the homeless over others being interred. Sometimes, he and his crew are the only people on hand to bid farewell to the deceased.

“The only time we would know if they are homeless or not is if a loved one or a friend of the family or their friends have shown up and they tell us that sort of thing,” he said. He recalls one occasion where about 40 people from the Downtown Eastside came out to the service by vans and buses – “however they needed to get out here.” Sometimes, family of the homeless turn up after the fact.

But the final rest is only a prelude to tribute and commemoration, which is handled differently by various agencies. No one has ever died at Insite, the safe-injection site in the Downtown Eastside, but memorials for those who die homeless are especially important to the neighbourhood, said spokesperson Darwin Fisher. There are no newspaper obituaries for such individuals, Mr. Fisher said in an e-mail exchange. “But their life and the love and loss felt by the community needs to be acknowledged.”

At Insite, memorials are held in a nearby community garden or a coffee lounge on site. They can feature singing, drumming, speeches or a simple prayer with informal stories. Often, there’s a memorial poster with a photo of the deceased.

“I was so shocked when I overheard a person say, ‘I can’t wait to die so I can get a poster like that …’ It’s so sad that the person who uttered that felt so little loving acknowledgement in their life,” Mr. Dixon wrote.

homeless

Pastor Bob Swann of the First Baptist Church in downtown Vancouver, who presided over Mr. Brylla’s memorial service, said he does about one such tribute a year.

“Every story is quite unique,” Mr. Swann said, adding there is a service whenever word comes in that someone associated with his church’s shelter program has died – in dumpsters and elsewhere on the unforgiving streets, without addresses.

“The memorial service is more about those who remain, to teach them that, ‘Yes. This person has passed away, but they did, this, this and this,’ and they meant something to us and were part of our community.”

He said death equalizes the homeless with those who are better off. “We all leave here with nothing,” he said.

Complete Article HERE!

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