Expanded care on the Journey Home

The journey home has gotten a little easier for some of Toronto’s 8,500 homeless people in shelters and out on the street any given night.

A $2-million expansion and total renovation of the Journey Home Hospice in downtown Toronto will enable St. Elizabeth Health Care to care for dying homeless men in new and better ways, and care for more of them.

Expanding from four to 10 beds, this hospice helps some of the most vulnerable Canadians through their last days or weeks. But Journey Home is more than just a last chance for a dignified death. It’s also a teaching and research facility.

“We learn every day here,” said Journey Home medical director Dr. Sheri Bergeron. “Our patients teach us things. The staff teach us things. There’s opportunity to learn more and then share that information.”

The vulnerability of the population can’t be overstated. About 75 per cent of people on the street have at least one serious health condition. They are five times more likely to have heart disease, four times more likely to have cancer than the general population.

The expansion of Journey Home is first of all an opportunity to care for more people. But it’s also a chance to learn more about how to best care for them. The patient population has higher levels of mental illness, layered on top of physical diseases that brought them into the hospice. Since April 2018, when it opened in a largely improvised space carved out of a couple of apartments in a 10-storey apartment building, Journey Home has developed specialized policies and procedures to manage complex cases, ease patient symptoms and address their patients’ circumstances from every angle — physical, mental and spiritual.

“This is just as important from a science standpoint, an understanding standpoint,” Bergeron said. “Everybody is approaching end-of-life at some point. How we can care for those people is a different philosophy of care and we should look at it.”

Bergeron, who teaches palliative medicine at Western University’s Schulich School of Medicine and Dentistry in London, Ont., brings residents and medical students into Journey Home to see the full scope of palliative medicine in a hospice setting. 

“I always try to make sure they see that there’s a lot of medicine in what we do, but there’s also a lot of art in what we do,” she said.

If Journey Home serves to train more doctors and nurses and grow the hospice movement in Ontario, that’s exactly what the Iacobelli family was hoping for with its $1-million donation to the project, Henry Iacobelli told The Catholic Register.

“That hospice actually is not only just a hospice where people are accepted and they come in for their last little bit of time here on Earth,” said Iacobelli, whose family produces Unico and Primo brand foods in Kingsville, Ont. “They actually are a training facility for any other community that wants to get something like that going in their town.”

The Iacobelli donation was half of the $2-million price tag to transform the old hospice into a modern medical facility that has the look and feel of home with original artwork scattered through the rooms, a fireplace in the living room and a welcoming kitchen generously stocked with cookies and treats. All of that money came from charitable gifts because the province doesn’t fund any of the up-front capital costs of building a hospice.

“It’s a good place to put some money. It’s worthwhile,” said Iacobelli. “Why doesn’t the government do it? I don’t know.”

“This is a labour of love, there’s no doubt about that,” said St. Elizabeth Health Foundation director Nancy Lefebre. “This is really looking at the whole raison d’etre of our social enterprise, to actually make a difference and make an impact and to care for those populations that are more vulnerable.”

Lefebre senses a shift in public attitudes about hospice and palliative care — a shift that may change funding priorities for governments.

“Society doesn’t really want to talk about death and dying. They don’t really want to think about it,” she said. “You have the homeless and the vulnerably housed population on top of that — also an issue that society has a hard time wrapping their arms around.”

But if we ever do think about how well we as a society care for the dying, then how well we care for the most rejected, vulnerable and isolated people is the right measuring stick, according to Lefebre. 

“We will see a change over the next while,” she said. “There will be more people like us who are going to be pushing and informing and trying to change things around.”

All hospices, but especially Journey Home, can act as hubs for a full range of palliative care offered in the community. In the spectrum of palliative care it sits between home care and the kind of complex palliative care offered in hospitals. In Lefebre’s view, each hospice is a keystone in building a complete palliative care system.

“We have this saying — we’re going where they’re going,” she said. It’s a do-unto-others situation — we should provide for them the dignity in dying we wish for ourselves.

“I’m excited for the patients to see it,” said Bergeron as the just completed space was put on display Dec. 15. “Our staff is super-excited and engaged to have more patients that we can help and support here.”