Student learns how end-of-life compassion helps those living on Calgary streets

Courtney Petruik hopes her PhD dissertation will inform practice and improve end-of-life care for people who are homeless. The University of Calgary sociology student is riding along with Calgary’s Allied Palliative Mobile Program (CAMPP) to observe and document the service that provides care to one of Calgary’s most vulnerable populations — homeless people who are preparing to die.

“The work CAMPP does is absolutely amazing. I tell my family being with the team is the best part of my week, although many people find that hard to understand since the work is about death and homelessness,” says Petruik. “What people can’t see is that you’re not watching people suffer, you’re watching people come out of suffering which isn’t often equated with end-of-life care.”

• Photo above: Courtney Petruik in the Taylor Family Digital Library. Photo by Kelly Johnston, Cumming School of Medicine 

Petruik will observe and interview the CAMPP team and workers at support agencies to discover what’s involved in providing end-of-life care to people who are homeless. She’ll investigate how that care is carried out and organized, and how larger systems like our provincial health-care system mediate and influence the work. She will also speak to CAMPP clients to learn about their experience, how they are managing serious health problems and their wishes concerning end-of-life care.

“I observed a CAMPP team member providing care to a client at a detox centre. This is a place with a lot of people in a room, all on mats on a cement floor. It is not where you would typically expect end-of-life care to be offered,” says Petruik. “I have witnessed the team meet clients in houses where the client is couch surfing, at different spots downtown, and at ravines in our city where their camp is set up. The team goes wherever the client is.”

A challenge to 'do better' 

Dr. Simon Colgan, MD, is a palliative care doctor, and a member of the O’Brien Institute for Public Health at the Cumming School of Medicine (CSM). A few years ago, Colgan met a homeless woman who had a very poor end-of-life experience. Before her death, she told Colgan, “There’s a way to do this better.”

It’s something Colgan firmly believes and the woman’s words became the driver behind CAMPP. As a core faculty advisor to the Street CCRED (Community Capacity in: Research, Education, and Development) Collaborative, Colgan and team launched CAMPP in 2015. With support from the O’Brien Institute and start-up funding from Calgary Foundation, Saint Elizabeth Health Care (Toronto) and private donor Heather Edwards (in memory of Sean Fowler), the CAMPP team was born. It’s made up of individuals connected with UCalgary, CUPS and health care.

• Listen to a podcast interview with Simon Colgan

“People with terminal illnesses were dying behind grocery stores in our city. We have excellent palliative care services in our province, but most are set up for people who have the means and know-how to navigate the system,” says Colgan, a clinical lecturer in the Department of Oncology at the CSM. “For those who are homeless, and may have addictions and mental health issues, accessing health care is extremely difficult. These people are highly stigmatized.”

Colgan says CAMPP is set up to complement, not duplicate services. CAMPP networks with hospitals, Home Care and primary care. Team members offer medical support, and connect clients to social and community supports, like the Calgary Drop-In Centre (the DI).

“It’s been amazing to see how much people improve, even at the end of life when they are supported,” says Genevieve Wright, manager of services for the DI. “We’ve actually had people come to us for palliative care, who end up getting better, and finding permanent housing, where the CAMPP team helps care for them again.”

The DI now has a few palliative beds and a number of other shelters in the city also offer palliative care. Colgan says it’s amazing to have options for people who don’t feel that they fit in the mainstream system.

“You need to approach people with real humility, and sometimes just listen,” says Colgan. “We offer relationship-centred care, we look after people who feel stigmatized.

They don’t reach out, they sometimes end up in emergency rooms because they lack simple supports as their situation worsens.

CAMPP is coming to the end of its start-up funding and is looking to secure a sustainable funding base. Petruik hopes her research will help policy-makers understand the unique needs and experience of someone who is homeless and at the end of their life.

“Although I’m still in the early stage of the research process, what’s been surprising to me is the depth and richness of the relationships the members of the CAMPP team build with clients. It’s critical when you’re working with clients who mistrust our structured system and face stigmatization,” says Petruik. “What I’ve witnessed with CAMPP has provided me with a  valuable lesson in the central importance of building relationships and trust with people and behaving with empathy and humanity in delivering medical care at the end of life. It’s not poking and prodding and clinical. The work is compassionate, and the team meets people where they’re at and it makes a difference.”