Navigating and strengthening palliative care access in unhoused and structurally vulnerable persons using a community care lens in Hamilton, Ontario

Unhoused and structurally vulnerable (USV) individuals face disproportionately high rates of premature mortality and limited access to palliative and end-of-life (EOL) care. Despite clear needs, systemic barriers—such as stigma, fragmented services, and rigid policies—impede equitable care. In Hamilton, Ontario, homelessness has surged by 44% since 2021, yet little is known about current palliative care practices for USV populations. This qualitative descriptive study explores healthcare providers’ perspectives on palliative care delivery, barriers, and facilitators through semi-structured interviews and inductive content analysis. Early findings reveal variability in providers’ understanding of palliative care, ranging from upstream interventions to EOL and MAID.  USV individuals experience mistrust, stigma, and lack of personal supports, compounded by fragmented communication, poor discharge planning, and resource constraints. Care remains provider-centric, neglecting lived experiences, while policies like fixed-address requirements hinder access. Participants emphasized the need for flexible, harm-reduction-oriented models and improved coordination across care settings. Acute care environments were identified as particularly problematic due to discharge pressures and unmet needs. The study is expanding to include community sites and administrative data, transitioning toward a mixed-methods design to inform systemic reforms and future interventions. The research team is also submitting the project for various funding opportunities.

PIs: Alex Farag and Priya Gupta  

Contact: Ashlinder Gill (gilla89@mcmaster.ca)