The Agenda with Steve Paikin (Audio) - The Last Journey Home

Episode Date: December 13, 2024

There are plenty of very vulnerable people living in Ontario, and tonight, we're going to look at some of the people who are possibly at the very bottom of the food chain. They are homeless, they are dying, and for the vast majority of them, they have nowhere to go. Which is why the Journey Home Hospice exists. It's a small home in downtown Toronto that tries to make the last days on earth for a handful of homeless people a little bit more civilized. SE Health helps run Journey Home and their chief operating officer Nancy Lefebre is here to tell us more.See omnystudio.com/listener for privacy information.

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We follow one story from the boardroom to the courtroom. And seek to understand what happens when beliefs collide. Where does freedom of religion end and freedom from discrimination begin? That's this season on Queries in Good Faith, a TVO original podcast. Follow and listen wherever you get your podcasts. There are plenty of very vulnerable people living in Ontario and tonight we're going to look at some of the people who are possibly at the very bottom of the food chain.

They are homeless, they are dying, and for the vast majority of them, they have nowhere to go. Which is why the Journey Home Hospice exists. It's a small home in downtown Toronto that tries to make the last days on Earth for a handful of homeless people a little bit more civilized. SE Health helps run Journey Home, and their Chief Operating Officer, Nancy LaFeber, is here to tell us more. Nancy, it's good to meet you.

Great, it's nice to meet you too. Welcome to TVO. I've got to do a full disclosure thing off the top here. My wife is a health policy consultant. I think you know her. I do. She has done work for SE Health in the past, and so we put that on the record

in the interest of full disclosure. Thank you so much. When did Journey Home Hospice start operations? Yeah, so we started operations back in 2018, actually. Is that just in Toronto? Just in Toronto, and we started off with four beds. Wanted to kind of test it out, see what we needed to learn from establishing the hospice.

And then in 2020 we expanded to 10 beds. And then three years later we expanded to another three beds, so 13 beds. And more recently we actually established a satellite site down in Windsor. How many beds there? Just three beds there. Three beds there.

Yeah, three beds there. So 16 altogether. Yes. My hunch is you need a lot more than that to get the job done. Let's talk about the job. Why is it necessary that you do what you do? Well, first of all, there's about 7,000 people on the streets at any point in time in downtown Toronto alone, right?

And you may not think of it, but when you walk alone right and you know you may not think of it but when you walk by them and you see them and not realizing some of them are very sick and have are at their end of life have palliative care diagnosis there's really very few places for them to go to die because they don't have a home that's why they're on the streets and so they can go to the hospital but they're not comfortable in the hospital they don't their street family is often not involved in visiting in there. So we've established a specialized hospice is really what it is.

A specialized hospice is the place for them to go that they're well taken care of, they're respected, there's no judgment. Often these individuals have mental health and addictions issues as well too, so we have specialized services within that. The assumption is that these are, your clientele are pretty much all middle-aged older white men. Is that the case? No, not really. No, no. We have quite a wide variety. We do have younger in the teens. One of our first first patients was a young girl that died at the hospice, right up to 60, 65 years old.

Not elderly, 60, 65 years old. People who live on the street die at a much younger age than people who are not living on the street. Probably half the age, I would say most of them die around 40 years of age, 42 years of age is their lifespan, so it's quite short. If you are homeless right now, and if you are at or towards the end of your life, maybe you've got an incurable disease, maybe who knows, whatever you've got, what are your options today?

Well your options are to continue living on the street, and many do choose to continue to live on the street. They can also go to the hospital, or as as I say we have this specialized service now in Toronto for them to live by. Some actually it's interesting some individuals do come into the home and then decide that they don't want to live in the space they want to live on the street with their street family so what they might do is leave their medications at our home so that they can come in and get their meds so that there's no issues with any theft or anything like that

while they're on the street. So why would a homeless person facing imminent death not want to die in a hospital? Well I think that there is a different type of approach to care within a hospital and these individuals have very specialized needs. They often come from traumatic backgrounds and histories. They are often in the midst of taking drugs and narcotics and so on and so forth and so when they go into the hospital you're in a whole different kind of world. I think in our hospice we really provide specialized care that's driven by the patient in terms of what they want to do. We have a managed alcohol program, we have a managed drug program

so that the idea is eventually that we move them into prescription medications that they can use to manage their pain and get them off the street drugs that they were using while they were out on the street. Now that's interesting because if somebody's dying why do you care about whether or not they get off the drugs they're on? You don't really care if they get off the drugs but it makes the pain more manageable. So they're using street drugs for managing their pain where we're using prescriptive drugs that are a bit more manageable. But in terms of things such as you know cannabis and alcohol we're never going to you know we have it available we serve you know we

help them get through that and you know what's interesting actually is many find they first come in and they taper themselves off because they're pain-free, they're comfortable, getting three square meals a day, lots of TLC from our volunteers. Do your clients typically have nobody else in their lives who can advocate for them? Yes, that's a good case. Typically it is the case. Now I must say some of the work that we do do is to help find families or help locate

families if the individual so chooses that. that we do do is to help find families or help locate families. If the individual so chooses that there have been opportunities where we have brought families back together or loved ones together or friends of theirs that they haven't seen for a long time and do that. But typically they are quite alone and it's just their street family who are their family. I don't know if this is even possible to answer, but what are they typically dying of when they come to you? Yeah, any type of cancer, just like the regular population.

That's predominantly what they are. Some of the elder ones have more of chronic diseases, congestive heart failure, chronic lung failure, those types of things. But predominantly it's a cancer-related illness. And how long are they typically with you? So they are with us for three months, usually typically, which is interesting because typically in hospices people stay for about 12 to 14 days before they pass on. But what we find in the hospice here, they come into the hospice, they get good care, good food,

they're put on proper medications to manage their pain and they start to feel better and they start to rebound to a certain degree they're still on an end-of-life trajectory but they do tend to get better so their length of stay is longer within our hospice. Do you have a clue as to what kind of demand there actually is out there for this kind of thing? Well we're full and we have a waiting list. So I would say there's a pretty high demand. How many names on the waiting list?

How many names on the waiting list? That I'm not sure of. But that you even have a waiting list to, you know, get into a place where you're going to carry out the end of your life and the rest of the days. So it says something, I think, about the need. You know, one of the things that we did do is because we've also noticed as I said that people get better when they come into the hospice for a period of time. We opened another

three beds on another floor within the building. We partnered with Homes First and used space within renovated space within their facility. And what happens is that when people get better instead of discharging them to the street or sending them back out onto the street where they certainly deteriorate, we have what you might think is like a step down area where we move them down to the floor where they're much more independent. They don't require care.

And either help them find housing, or if they do deteriorate, then we move them back up to the floor where the hospice services are provided. Let's take a look at what you folks do. All right. Sheldon, if you would, a clip please. I'm here because I'm dying from cancer. I mean, I've run a pretty hardcore life,

you know, running the streets and not caring about anybody or anything but myself. I have been a nurse for many, many years, and I've just seen the phenomenal need that people have at the end of life care. And so when we think about people who are living on the street, when most people want to die at home, if you don't have a home, where do you go to die?

And so what should we as a society be doing for them? And I think that's one thing here at Journey Home Hospice. We're trying to tackle two really tough societal issues, right? Nobody likes to talk about dying and nobody likes to deal with the issue of homelessness. You know the people that you are taking care of, how do I put this? You're trying to get additional resources for people who are, as we suggested in the intro, really at the

bottom of people's priority list. These are homeless people, number one, and these are people who are, as we suggested in the intro, really at the bottom of people's priority list. These are homeless people, number one, and these are people who are going to die imminently, number two. How do you get people to care about that population? Well, you know, that's a very interesting question, because you're right, there are very two significant societal issues, right?

Nobody likes, nobody knows what to do for the homeless population, and nobody likes to talk about end-of-life care. So you know what, how our approach is that everybody is going to die and everybody can relate to having family members or people die and I think how we get to people to connect with it is that nobody really wants to die alone and certainly nobody wants to die on the street and homeless issues is such a large issue. We hope that we're shining a light on just a part of it to have people understand it and to give it a humane element because you know the patients that we serve and

the people that we have in our homes they don't start out being homeless. They often have a lot of trauma and significant life circumstances that happen to them that lead them to being homeless. Does this kind of service that you offer, I mean this presumably is a model for any jurisdiction that wanted to do it, does it exist elsewhere? So the only other hospice that I'm aware of for the homeless population is in Ottawa and it was started, there was a mission in Ottawa, a mission house for men in Ottawa and they expanded into then providing end of life care services there. So that is really to be honest with, where I got the idea from.

And after I went to visit them, I came back to our organization, St. Elizabeth Health Care, and said, I think this is what we should do. And they said, we absolutely agree with you, like, make it happen. You are in an emotional business. Yes. And we're going to show some of that as well. Shilden, clip if you please. One patient, I went into his room and the nurse was busy

and when she came in she said, oh, he's dying. I'm like, no. She said yes. And we moved him onto the bed. Five minutes later he was gone. And I felt bad because I didn't know. I didn't know. I didn't know this hurt. How difficult a business is it to be in when you know that everybody you are serving, sooner or later, and probably sooner, is going out the door in a casket?

Yeah. You know, it's a calling. It takes a special person to work in a hospice is that finding the right people to work there, finding people that are dedicated to the cause, that are non-judgmental, that are open, and like the staff person of ours that just wants to be there to hold people's hands and care for them and make sure that they have the best end of life journey that they possibly can. What kind of staff do you have?

So we have nurses, we have occupational therapists, we have personal support workers, and we have a phenomenal group of volunteers. And really I have to say if it wasn't for the volunteers it would be very difficult to run the place as well as we do because they provide a lot of companionship. They may be sitting reading a book, listening to stories, watching a movie, sharing music interests, taking them for a walk if they're that healthy to be able to go outside or putting them in a wheelchair, taking them up to the balcony, the rooftop upstairs. They provide a lot of great care.

Do your clients ever get visitors? Yes, yes, yes they do. They do. They have street family. And so we'd get all kinds of visitors. It's a very fun, interesting place. There's a lot of living going on there, actually, while people are dying, which makes it very unique.

Because I would think this clientele that you deal with would be particularly mistrustful of institutions in society, particularly in the health care system, which they've probably had some run-ins with over the years. How long does it take to sort of get them to relax and realize that they're among friends? Yeah, it's a good point. It takes a little while.

So when we first meet them, we meet them out in the community. When they are referred to us, we go to the community and meet them out in the community and have a conversation with them to see where they're at and if they're ready. And you're right, they are fearful of healthcare institutions,

and so are any institution for that matter. So we have come and visited, just come and see what you think, see who's there, see how you feel. And sometimes they're come in right away and they're fine. And then other times it takes them a little while longer till they have a comfort level. They may come back a few days to visit

and see the people there and eventually they move in. And it's usually a couple of weeks before they settle in to any kind of routine, or not so much of a routine, but they feel very comfortable. Like you saw the story of Peter. His story goes on to say what his experience was all about. Who volunteers for this kind of work? The best people, the best people.

And I have to say, even during the pandemic, our volunteers continue to come to the hospice to work within the hospital. So people that are caring, that are kind, people that may have had experience with loved ones themselves, caring for them at home, or they may have individuals that they know that have lived on the streets themselves. So all kinds of people from young to old

and everything in between. So we know you've got 16 beds right now. Yes. What's possible? You know, I think anything is possible. The challenge always is we do get partially funded by the government which is fantastic but we do have to fundraise for the rest of the operations to pay our staff, to bring the food in, pay for rent, all those types of things right. So for us we're looking at a national expansion kind of program,

and we may do that ourselves or we may work in partnerships. What we're finding is that we've kind of become a bit of a center of excellence for people to come and learn about how to establish hospices for homeless, from people in the States to people from right across Canada. So we are very willing and happy to share our knowledge and our experience and I must say that's one of the things I love about working in the hospice world. It's a very sharing community and so we hope that we'll either expand by sharing that knowledge and helping others establish hospices or

look to establish them ourselves. Well I should say for the record here even though Essie Health was a client of my wife's, I didn't hear about you through her. I was on the subway one day and one of your volunteers, Patrick McConkey, just walked up to me, introduced himself and started to tell me about you. And that's where I first learned about it and I thought, this sounds like a great story for our program. Yeah, isn't that amazing? And he's a great example of a volunteer, a volunteer that we have within the organization. He's very wonderful and very great with the individuals that live here.

He makes a difference in people's lives every day. I'll tell you what, he's a good salesman for you guys. Yeah, I'm good, yeah. That's great. Yeah, I'll tell you that. Thanks so much for coming in. This was really from SC Health, the Chief Operating Officer, Nancy Lefebvre. Thanks so much, Nancy.

Thank you very much. Thanks.