New end-of-life doula services focus on rural, houseless populations

— OHSU School of Nursing alum aims to make end-of-life a social, not medical event

By Christi Richardson-Zboralski

As a hospice nurse, Erin Collins, M.N.E., RN, observed that many of her patients were afraid of dying, in denial of their imminent death, and consequently unprepared for it.

Now, she’s seeking to change that: Collins’ new organization, The Peaceful Presence Project, views compassionate end-of-life care as a basic human right, and is creating a social death care movement through education for clinicians, volunteer-based programs, and an innovative concept called end-of-life doulas.

“As health care providers, it is not always about saving lives at all costs, it’s about supporting someone to live and die well,” Collins said. “That often includes where they want to die and who they want to be present.”

Collins is a certified hospice and palliative care nurse with 16 years’ experience in oncology and end-of-life care. She recently completed a Master of Science in Nursing Education at the OHSU School of Nursing, Portland campus, and was selected as a 2022 Cambia Health Foundation Sojourns Scholar.

The mission of The Peaceful Presence Project is to reimagine the way communities talk about, plan for and experience serious and terminal illnesses. Its approach is based on the compassionate communities model of end-of-life care, which asserts people facing serious illness should spend 5% of their time with a health care professional, and views the end-of-life as a social event with a medical component — rather than the other way around. Their doula program helps fill the 95% of time people aren’t face-to-face with their health care provider.

Doulas are people who are trained to serve. Many people are familiar with birth and postpartum doulas, who serve families during and after the birth of a child. End-of-life or death doulas serve families during the end of the life cycle. End-of-life doula courses provide training in how to be a present and active listener; create a calm and compassionate environment; and provide non-medical comfort measures, such as distraction, guided imagery and repositioning to help alleviate symptoms. Trained volunteers may help with legacy projects, including collages, audio or video recordings, and other ways to display physical objects. When needed, they help with memorial planning.

The trainings emphasize how to facilitate compassionate discussions about death-related topics. In 2023, Collins will develop a continuing education program for rural health care workers through her Sojourns Scholar project to improve access to palliative care in communities where specialists often don’t exist.

Community-based end-of-life support

Lily Myers Kaplan speaks highly of The Peaceful Presence doula training she took in 2022. Meyers Kaplan is author of two books on loss and legacy, co-founder of The Spirit of Resh Foundation, the Ashland Death Café and The Living/Dying Alliance of Southern Oregon.

“There was a particular session on approaching end-of-life with veterans, which helped me see the need for diverse approaches to different populations. The difference in end-of-life support between those who have lived in a rural setting, caring for the land, or being actively reliant on their physicality versus someone who has had a more traditional or urban life is quite distinct.

“For example, caregivers who may be responsible for vast swaths of land — anywhere from 20 to 80 acres or more — need support from others who understand their needs,” said Myers Kaplan, who lives in the Applegate Valley, a rural area of Oregon that includes large stretches of land that provide solitude and a level of independence that most urban lifestyles don’t experience.

A caregiver in Depoe Bay reluctantly accepted help from The Peaceful Presence Project after his wife got him on board. After several long years of treatment and many ups and downs, Ray Burleigh’s adult daughter, Becky, had reached a point in her cancer treatment where it no longer worked. Burleigh had strong doubts when the hospice nurse brought up the topic. However, his wife, Jeni, said yes to the help.

With the support of two death doulas from The Peaceful Presence Project, Elizabeth and Erin, the Burleighs found some measure of relief. The death doulas told the family they would bring community support from around the Bend area.

“I was still not convinced. We needed practical help. Becky’s house is hard to heat and she was concerned they were spending too much money on keeping the house warm. It’s heated by a wood stove,” said Ray. “I told them to bring us some wood, not expecting anything. Two nights later, a truckload of wood came — not just one bundle, a truckload. I was shocked! We couldn’t have done this without Elizabeth and the doulas.”

Without the doulas’ help, Ray said they would have had to put Becky in the hospital, and possibly ended up sick themselves.

“The doulas provided night-shift help because we weren’t getting any sleep. They helped with groceries, created a schedule for visiting hours, and the fire,” he said.

Elizabeth and Erin identified 25 people in the city of Bend who were willing to help them out, including neighbors, and many people who are now friends of the Burleighs. Jeni’s family from the same area were also there to help.

Because of his time alongside these doulas, Ray has decided to take The Peaceful Presence Project doula training.

End-of-life care for under-resourced communities

Lora Munn, a yoga teacher who is National End-of-life Doula Alliance proficient, took The Peaceful Presence Project training in 2021.

“End-of-life care is not only being talked about in rural communities, but also actually being spread throughout rural communities thanks to the folks at The Peaceful Presence Project,” she said.  

Munn lives in White Salmon, Washington, and serves all communities located in the Columbia River Gorge. She said she understands that “folks in rural and houseless communities may not have access to resources for the dying and their loved ones in the same way that urban communities do. Because of my education and training through The PPP, I am able to provide these necessary services to my small community. Through my training, I learned how to provide compassionate care for all beings, regardless of housing status or location.”

Because palliative and end-of-life care resources are sparse within rural and houseless communities, Collins and her team facilitate advance care planning to encourage these populations, and others, to think about their end-of-life experience.

“Parts of the state where there is no hospice care or even palliative care need more resources, and one way to address that is to have support embedded in the community,” Collins said.

Through two grant-funded projects, doulas and public health interns have been trained to hold advance care planning “pop-ups” at a navigation center for people experiencing homelessness, as well as in rural health clinics. Navigation centers are low-barrier emergency shelters that are open seven days per week and connect individuals and families with health services, permanent housing and public benefits.

Conversations about what their death experiences could entail are uncommon for people experiencing homelessness, Collins said. The general population tends to choose a spouse or family member as their medical decision-maker. But within the homeless population, a non-family member or someone in their so-called street family is more likely to be their choice. In the absence of a named decision-maker, the hospital may call an estranged family member or someone with whom they are not in contact.

“Equitable care means providing equitable services,” Collins said. “This includes advance care planning for people who are experiencing homelessness. We found that many of these folks have never been asked what their preferences are at end-of-life.”

Educating health care professionals about palliative care

Although it’s important to educate people in the community, it doesn’t stop there. Collins emphasizes the importance of education for all health professionals about serious and terminal illnesses — which is not traditionally an in-depth part of the health care curriculum.

“Nurses and physicians don’t always know how to have those conversations. Palliative care should be part of all health education,” Collins said. “Not just a specialty, but a standard part of education.”

To get participants thinking about ways to support their patients, The Peaceful Presence Project asks them to reflect on key questions: How do you ask someone about what they want if they are dying? How can you have a compassionate conversation?

“Training in communication skills allows you to feel empowered as a provider and as a fellow human being,” said Eriko Onishi, M.D., an assistant professor of family medicine in the OHSU School of Medicine and a palliative care physician at Salem Hospital. “It makes you a better listener through your professional sense of curiosity about other people. You feel as if you are truly walking alongside your patients, guiding them in the right direction, instead of just feeling the way blindly, guessing at each step.

“It’s important to understand that it isn’t about exercising power or control over patients,” Onishi continued. “Rather, it is using this powerful communication tool to support everyone involved, to help them to feel safe because the situation itself is under control.”

Onishi is passionate about the need for such conversation skills training.

“To be a clinician, both knowledge and communication skills are equally essential — it’s never a one-or-the-other choice,” Onishi said. “As a physician, my job is to provide medical guidance to the patient and their family, guided by the best intentions and a caring heart. If I cannot do all of these things, I cannot do my job.”

Ultimately, Collins said, it’s up to the individual patients to discuss how they want to experience their end-of-life, knowing that flexibility and adaptability are key. Having a plan is important, and when things don’t go according to plan, community-based support for death and dying can alleviate a stressful process for all involved — providing what people need to live and die well.

Complete Article HERE!

Older Homeless People Are At Great Risk of Dying

Research Describes a “Health Shock” from Losing Housing Later in Life

By Laura Kurtzman

A quarter of the participants in a long-term study of older people experiencing homelessness in Oakland died within a few years of being enrolled, UC San Francisco researchers found.

The study, funded by the National Institute on Aging, recruited people who were 50 and older and homeless, and followed them for a median of 4.5 years. By interviewing people every six months about their health and housing status, researchers were able to examine how things like regaining housing, using drugs, and having various chronic conditions, such as diabetes, affected their risk of dying.

They found that people who first became homeless at age 50 or later were about 60 percent more likely to die than those who had become homeless earlier in life. But homelessness was a risk for everyone, and those who remained homeless were about 80 percent more likely to die than those who were able to return to housing.

Becoming homeless late in life is a major shock to the system.

The median age of death was 64.6 years old, and the most common causes of death for people in the study were heart disease (14.5 percent), cancer (14.5 percent), and drug overdose (12 percent).

“Becoming homeless late in life is a major shock to the system,” said Margot Kushel, MD, who directs the Benioff Housing and Homelessness Initiative and is a professor of Medicine at UCSF and senior author of the study published August 29, 2022 in JAMA Internal Medicine.

“These untimely deaths highlight the critical need to prevent older adults from becoming homeless – and of intervening and rehousing those that do, quickly,” she said.

The study is unique for its prospective design. Previous studies of mortality in homeless populations were retrospective and drew information from medical records. By contrast, the current study – Health Outcomes of People Experiencing Homelessness in Older Middle agE (HOPE HOME) – followed a group of people, whether or not they received health care.

Many study participants had serious conditions that went untreated.

“We looked at how frequently people reported diagnosis of heart disease or cancer before dying of these diseases. It was really low,” said Rebecca Brown, MD, affiliated assistant professor of medicine in the Division of Geriatrics at UCSF. “We think this represents a lack of access to care and delayed diagnosis. Often, we didn’t even know people were ill because they didn’t report it in their six-month interviews. But we found it on their death certificates.”

Researchers went to great lengths to track down what happened to the people in the study when they missed check-ins and couldn’t otherwise be accounted for, including looking at photos of unidentified deaths at the coroner’s office, reviewing California state death records to match their participants’ names and dates of birth, querying emergency contacts, searching social media, and reading online obituaries.

They found that as of Dec. 31, 2021, 117 of the 450 people had died since the study began enrolling in 2013. Nearly 40 percent (45) occurred after the pandemic started in March of 2020, but just three of those deaths were from COVID-19. Participants entered the study in two waves, with 350 enrolled in 2013-14 and another 100 enrolled in 2017-18; 101 of the deaths were from the first wave, and 16 were from the second.

Mortality rates were high compared to the general Oakland population. The risk of dying was 3 times higher for men and 5 times higher for women, compared to people of the same age and sex in Oakland. The median age for participants entering the study was 58, and 80 percent were black; 76 percent were male, and 24 percent were female.

The study also contained detailed information about people’s use of drugs and alcohol, as well as their mental health. But drug and alcohol use itself was not independently associated with death.

“The streets are just no place to live,” said Johná Wilcoxen, 72, who spent more than a decade living in his car when he lost Section 8 housing because his children moved out. Through his ordeal he continued working as a plumber, which gave him a place to go during the day and money for food. “The more people as we can get off the street, the better,” he said.

Complete Article HERE!

Anger, sadness dominate day of mourning for homeless people who died in L.A. this year

Pancake, a community organizer, leads supporters as they march in downtown Los Angeles in tribute to homeless who died this year.

By Gale Holland

A joyous New Orleans-style Second Line parade to honor the roughly 1,000 homeless people who have died in Los Angeles County this year turned to anger on Friday, as skid row mourners stopped at City Hall to denounce elected officials for not halting the growing death toll.

Dozens of skid row residents and advocates, all decked out in Mardi Gras beads and flying black, gold and purple balloons, chanted: “Three a day! Too many!” They waved their fists at the windows of City Hall, where a homeless man in his 50s was found dead Tuesday night.

The parade and angry demonstration were part of National Homeless Persons Memorial Day, marked in dozens of cities.

Lorraine Morland speaks and sings to a crowd of supporters gathered outside City Hall to pay tribute to homeless people who have died this year in Los Angeles.

L.A.’s day of mourning began soberly at the James Wood Community Center with prayers, songs and the traditional recitation of the names of all people who died at skid row missions and programs. Later, advocates planned to release candles at Echo Park Lake, where dozens of people have been living and dying in tents over the past year.

The Los Angeles County Public Health found in October that deaths among homeless people have increased each year, from 536 in 2013 to 1,047 in 2018. The tally so far this year is 963, they said.

Pete White of the Los Angeles Community Action Network, the parade organizer, accused City Atty. Mike Feuer of hypocrisy for expressing sadness over the homeless man who died outside City Hall, the same week the U.S. Supreme Court declined to hear a landmark homelessness case that curbs police powers to clear homeless encampments when there aren’t enough shelter beds available.

Feuer and officials from several other cities and counties across California had asked the high court to either clarify or overturn the lower court ruling in City of Boise vs. Martin.

“The city attorney had the audacity to hold a press conference [about the death] … when, days before, his office was trying to figure out how to criminalize that man,” White said.

Rob Wilcox, the city attorney spokesman, said Feuer wanted the court to clarify the Boise ruling, not to extend police powers over homeless people.

Feuer announced the man’s death at a press conference on Wednesday morning.

“He was someone’s son. He might’ve been somebody’s dad or somebody’s brother,” Feuer said. “I don’t know. But I do know that he died alone, and if there is any truth to statistics, he is not alone.”

The first parade to mark National Homeless Persons Memorial Day took off at noon Friday from San Julian Park, accompanied by drums, a trumpet, a keyboard, bicycles festooned with beads and Christmas garlands, and a giant banner that included photos of skid row residents who had died. It was labeled “Death by neglect” and contained a dot map of every homeless death site in Los Angeles County in the past year.

Several singers led the crowd in “Wade in the Water” and other civil rights anthems. Stephanie Arnold Williams, a longtime skid row advocate, sped around the crowd in red sequined skates, live streaming the parade on Facebook from a solar-powered tablet strapped to her back.

“When death comes to the doorstep of City Hall, you know we must respond,” White said. “We are going to set up shrines to show our people didn’t die in vain.”

Several of the dead were remembered by name, including Rodney Evans, who died on skid row waiting to get housing.

The parade eventually returned to the skid row corner where Dwayne Fields, a longtime skid row street musician, was killed in August when his tent was set on fire in what authorities said was an intentional act.

A memorial sits Friday at the site where homeless man Darrel Fields was set on fire and died.

Jonathan Early, 38, who also was homeless, has been charged in Fields’ death. The death — and that of his partner, Valarie Wertlow, a month later — underscores the stakes in the epidemic of homeless deaths.

“Fields was a Jimi Hendrix impersonator in Las Vegas, and he was a better guitarist than Jimi Hendrix,” Anderson said. “It’s like genius is being snuffed out. This is all of our fight.”

In Echo Lake Park, homeless advocates place floating candles containing the names of homeless people who have died.

Complete Article HERE!

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

by Mariana Dale

[I]nside 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!

Homeless and Dying in America

Facing the End of Life Alone

By Betty R. Ferrell, PhD, RN

As Homeless Persons Near the End of Life

[S]tatistics 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.


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!

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

‘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!

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


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


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.


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!