Hektoen International

A Journal of Medical Humanities

PEACH: Providing end of life care for the homeless

Lea Mendes
Lisbon, Portugal


Retired homeless fisherman
(Photo by Pedro Ribeiro Simões, Wikipedia Commons)

Homeless people make up a Fourth World population in industrialized as well as developing countries. Homelessness creates a higher risk for disease and premature death. An innovative Canadian program provides care for those who are homeless at the end of life, especially for those who might otherwise die alone.

PEACH (Palliative Education and Care for the Homeless) is a mobile palliative care program that offers vulnerable individuals the dignity of choosing where to receive care in their final days. An interdisciplinary team provides a family presence. This hands-on approach “has the potential to improve quality of life, in some cases, even prolonging life,”1 says Dr. Naheed Dosani, who drives the borderless “PEACH-mobile” (his Honda Civic) to make rounds on patients every day.2 Dr. Dosani’s remarkable work inspired his alma mater, The University of Ontario Institute of Technology, to create a scholarship in his name for a student who demonstrates involvement and personal growth through humanitarian action.3

PEACH is funded by ICHA, or Inner City Health Associates, a group affiliated with St. Michael’s Hospital and the University of Toronto via the Ontario Ministry of Health and Long-Term Care. PEACH has comforted many homeless people since it was launched in 2014. To help ease pain, Dr. Dosani emphasizes three psycho-social principles: be accessible, be flexible and be humanistic. PEACH stands for a better quality of life and death; “live well, die well,” maintaining that everyone can have attention, kindness and love.4, 5

“Being sick is hard. Being sick and homeless can be even harder,” says Dr. Dosani. These “people who slipped through the cracks” lead very rough lives. They may face very difficult and premature deaths. The average life expectancy for a homeless person is between thirty-four and forty-seven years (“an early death sentence”—about half of the average Canadian life expectancy), and mortality rates are 2.3 to 4 times higher than the general population. Thirty-four to fifty-nine per cent of the time homeless patients die in hospitals. PEACH works with this population at risk of dying in social isolation.

There are 150,000 to 300,000 homeless people in Canada. Around 5,000 of these live in Toronto, which is the area served by the PEACH Initiative. Examples of similar programs in Canada include CAMPP, Calgary’s Allied Mobile Palliative Program, and the Old Brewery Mission in Montreal. Médecins du Monde also delivers care to marginalized populations throughout Canada in community-based clinics.

Namarig Ahmed (the PEACH program coordinator) and Dr. Dosani partnered with palliative care centers such as St. Michael’s Palliative Care Unit, Toronto Central CCAC, The Toronto Grace Health Centre, Kensington Hospice, and the Temmy Latner Center for Palliative Care, prior to launching PEACH. Dr. Dosani, a physician at Osler’s Brampton Civic Hospital in Ontario, says that “palliative care isn’t just about dying, it’s about living well.” He encourages homeless patients to enjoy life and the care of professionals at each stage of their illness or disease. Dr. Dosani hopes there will be a second mobile unit that will support him in his work. PEACH and such programs will also try, if asked, to reconnect patients with their families, from whom they may have been estranged for many years. That is one of Dan Thibideau’s last wishes, second only to being able to pass away in his furnished unit at the Fred Victor transitional housing center in downtown Toronto. Thibideau is a New Brunswick native who moved to Toronto many years ago; with cancer, he was the first patient of PEACH program.6

Many of those who end up on the street are there because of psychiatric disorders, substance use, or both. High housing costs also contribute to homelessness. “They die of problems that are generally a consequence of addiction or mental health,” says Dr. Jeff Turnbull, medical director of the Inner City Health Project for the homeless in Ottawa and chief of staff at The Ottawa Hospital. Similar efforts to help are a found in cities around the globe such as Seattle, Boston, and Brisbane, and their numbers are growing. For example, Volunteers of America supports a variety of programs to help the homeless reach self-sufficiency in the United States.7

PEACH uses a multidisciplinary approach to attend to the physical, emotional, and spiritual needs of the homeless at the end of life. This type of holistic care is a way to give all people the opportunity to feel less invisible, be treated with respect, and die with dignity.



  1. Palliative home care for the homeless», by Geoff Koehler , Toronto, 29th July 2014. Accessed on 25th January 2017 stmichaelshospital.com/media/detail.php?source=hospital_news/2014/20140805a_hn
  2. Doctor hits the road to deliver palliative care to Toronto´s homeless», by Kas Roussy, CBC News, 25th January 2017. Accessed on 30th January 2017. http://www.cbc.ca/news/health/toronto-calgary-homeless-palliative-care-health-end-of-life-1.3937391
  3. Naheed Dosani- Reaching out to the most vulnerable. Accessed on 1st February 2017. http://giving.uoit.ca/report-on-donor-philanthropy/outstanding-alumni/naheed-dosani.php
  4. Naheed Dosani- 30/08/14. Accessed on 30th January 2017 http://globalnews.ca/video/1505729/dr-naheed-dosani
  5. What´s a life worth? » Naheed Dosani/ TEDx Stouffville (uploaded on 9.05.2016). Accessed on 1st February 2017. https://www.youtube.com/watch?v=jcdm5fEqJmk
  6. Palliative care doctors working to aid homeless», by Terry Haig, 7th August 2014. Accessed on 30th January 2017 http://www.rcinet.ca/en/2014/08/07/palliative-care-doctors-working-to-aid-homeless/
  7. Volunteers of America- Assisting Homeless People. Accessed on 1st February 2017 https://www.voa.org/homeless-people



LEA MENDES was born in Lisbon, Portugal and grew up in a Portuguese and French environment with Canadian and European influences. She graduated from the University of Lisbon, sings in several choirs, and has a variety of cultural interests.


Spring 2017  |  Sections  |  Doctors, Patients, & Diseases

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.