The intersections of palliative care and homelessness in Canadian social policy
Walsh, J.J., Carter, R., Bosma, H., Cormier, E., Canham, S., & Sussman, T. (2025, June 17 - 19). The intersections of palliative care and homelessness in Canadian social policy. [Paper presentation]. 4th International Research Seminar EAPC Reference Group on Public Health and Palliative Care, Victoria, BC.
Background
The physical and emotional toll of homelessness on older adults results in increased rates of chronic illness, earlier onset of frailty, and decreased life-expectancies. The resulting palliative needs are generally not well met by current palliative service provision. As such, palliative care for this population is an important social issue for policy makers.
Policymakers can respond to these challenges by naming the issue in policy documents, allocating resources, and creating frameworks or guiding principles to inform action. While policy plays a crucial role in addressing this issue, the extent to which palliative care and homelessness are discussed in social policy is currently unknown, and we are not aware of any other analyses of this kind.
Objectives
Conduct a policy document analysis to examine how, if at all, policymakers in Canada are identifying and addressing the issue of palliative care for people experiencing homelessness through its inclusion in policies governing palliative care and/or homelessness.
Research approach
Content analysis of Canadian policy documents governing palliative care or homelessness. We analyzed policy documents based on geographic scope; and presence, level and type of content referencing homelessness and end-of life.
Findings & Relevance
The Canadian policy documents analysed rarely discuss the intersections of homelessness and palliative care. Of 75 documents, 42 contained no discussion of palliative care and homelessness, 13 addressed the issue indirectly (through broader concepts of social or health equity), 14 named the issue minimally without further elaboration, and only 6 documents discussed palliative care and homelessness significantly. Our analysis found differences within the level of discussion between the policy documents in the two sectors, with palliative care policy documents more frequently discussing the issue and the only documents to discuss the issue significantly. There were also differences in the content of discussion between the two sectors; bereavement and increased risk of homelessness following spousal death were discussed in homelessness documents but absent from palliative care documents. Conversely, calls to action were included in palliative care documents but missing from homelessness documents. Despite these gaps, the results suggest opportunities for increased collaboration, particularly pertaining to practices to address the end-of-life care needs of homeless older adults. The findings demonstrate the need for increased attention by Canadian policymakers to address palliative care for OPEH, as well as the potential areas ready for collaboration.
