PC for People Experiencing Homelessness: Naheed Dosani
GeriPal - A Geriatrics and Palliative Care Podcast
Release Date: 03/06/2025
Health and Wealth Shocks: Lauren Hunt, Rebecca Rodin, Tsai-Chin Cho
GeriPal - A Geriatrics and Palliative Care Podcast
famously characterized the end of life functional course of people with dementia as a slow dwindle over time. later found that people with dementia do indeed have persistent severe disability throughout the last year of their lives. But from our clinical work, many of us are familiar with people with dementia who experience sudden shocks to their health, think hip fracture, think hospitalization for pneumonia. Those disruptive events or shocks often portend a major decline in function from which people with dementia never fully recover. And they’re often a sign of (or cause...
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Transgender Health, Aging, and Advocacy: A Podcast with Noelle Marie Javier and Jace Flatt
GeriPal - A Geriatrics and Palliative Care Podcast
Happy Pride Month GeriPal listeners! Transgender issues are in the news. Just today (June 17th) as we record this podcast: Ezra Klein released a wonderful , the first openly transgender member of congress A judge ruled that focused on minority groups, including transgender people, were illegal and ordered the government to restore funding. It’s Pride month, and our guests remind us of the in the Stonewall riots, which started the modern fight for LGBTQI+ rights and liberation. Today’s guests are Noelle Marie Javier, a geriatrician and palliative care doc who tells her story...
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What You Should Know About Radiation Oncology: A Podcast with Anish Butala, Emily Martin and Evie Kalmar
GeriPal - A Geriatrics and Palliative Care Podcast
If you’re anything like me, you might find the process of what happens to patients when they visit a radiation oncologist somewhat mysterious. During my training, I didn’t receive much education about radiation oncology, and I’m not entirely sure what some of the terms mean (hypofractionated means fewer sessions, right?). Well, today’s podcast aims to clear up all these uncertainties. We’ve invited , and , a palliative care doctor and past president of the Society for Palliative Radiation Oncology (SPRO), to explain everything we should know about radiation oncology. Additionally, ,...
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Implementing Palliative Care in Nursing Homes
GeriPal - A Geriatrics and Palliative Care Podcast
The need for better palliative care in nursing homes is significant. Consider this: the majority of the 1.4 million adults residing in U.S. nursing homes grapple with serious illnesses, and roughly half experience dementia. Many also suffer from distressing symptoms like pain. In addition, about 25% of all deaths in the United States occur within these facilities. Despite these substantial needs, specialized palliative care beyond hospice is rare in nursing homes. Furthermore, only about half of nursing home residents nearing the end of life receive hospice care. So, how can we improve...
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Lucid Episodes: Andrea Gilmore-Bykovskyi & Andrew Peterson
GeriPal - A Geriatrics and Palliative Care Podcast
Have any of you watched the movie “”? At the end, one of the characters, who has dementia, experiences an episode of lucidity. When I watched it, between tears (I’m a complete softie) I remember thinking, “Oh no! This will give people false hope! That their loved one is ‘in there.’ If only they could find the right key to unlock the lock and let them out.” Today we talk about lucid episodes and what they might mean to the person with dementia, their family and loved ones, to philosophers, to clinicians, to neuroscientists. Our guests are Andrea...
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Music as Medicine: Jenny Chen, Tyler Jorgensen, & Theresa Allison
GeriPal - A Geriatrics and Palliative Care Podcast
As you know, dear listeners, I love music. We start each podcast with a song in part to shift the frame, taking people out of their academic selves and into a more informal conversation. Well, today’s guests love music at least as much if not more than me, and they each make a strong case for music as medicine. Jenny Chen is a palliative care fellow at Yale who regularly sings for her seriously ill patients. Look for Jenny to potentially appear on the show (no lie). Tyler Jorgensen not only plays music for his patients, starting out with just pulling up a tune on his iPhone, he and others...
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Nudges for Prognosis and Comfort Care in the ICU: Kate Courtright, Scott Halpern, & Jaspal Singh
GeriPal - A Geriatrics and Palliative Care Podcast
Our main focus today was on to consider a more palliative approach to care. Our guests are all trained in critical care: Kate Courtright, Scott Halpern, and Jaspal Singh. Kate and Scott have additional training in palliative medicine. To start. we review: What is a nudge? Also called behavioral interventions, heuristics, and cognitive biases. Prior podcasts on the , and a different trial conducted by Kate and Scott in which the . What is sludge? I’d never heard the term, perhaps outside of Eric’s pejorative reference to my coffee after adding copious...
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Psilocybin in Serious Illness: A Podcast with James Downar, Ali John Zarrabi and Margaret Ross
GeriPal - A Geriatrics and Palliative Care Podcast
We’ve covered psychedelics on the podcast before—first in 2019 with , and then again in 2023 with Stacy Fischer, Brian Anderson, and Theora Cimino, focusing on the . In today’s episode, we’re taking a closer look at the current state of the science around one specific psychedelic: psilocybin. We'll discuss three recent clinical trials involving patients with serious illness, joined by our guests , , and . We begin with a refresher on psilocybin—what it is, how it might work, what conditions it may help treat (including demoralization), and how it’s typically administered....
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HIV, Aging, and Palliative Care: Peter Selwyn and Meredith Greene
GeriPal - A Geriatrics and Palliative Care Podcast
Peter Selwyn, one of today’s guests, has been caring for people living with HIV for over 40 years. In that time, care of people with HIV has changed dramatically. Initially, there was no treatment, then treatments with marginal efficacy, complex schedules, and a tremendous burden of side effects and drug-drug interactions. The average age at death was in the 30s. Now, more people in the US die with HIV rather than from HIV. Treatment regimens are simplified, and the anti-viral drugs are well tolerated. People are living with HIV into advanced ages. The...
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Potentially Unsafe Low-evidence Treatments: Adam Marks, Laura Taylor, & Jill Schneiderhan
GeriPal - A Geriatrics and Palliative Care Podcast
More and more people are, “” Self-identified experts and influencers on (podcasts!) and social media endorse treatments that are potentially harmful and have little to no evidence of benefit, or have only been studied in animals. An increasing number of federal have a of endorsing such products. We and our guests have noticed that in our clinical practices, patients and caregivers seem to be asking for such treatments more frequently. Ivermectin to treat cancer. Stem cell treatments. Chelation therapy. Daneila Lamas wrote about this issue in the -after we...
info_outlineI was very proud to use the word “apotheosis” on today’s podcast. See if you can pick out the moment. I say something like, “Palliative care for people experiencing homelessness is, in many ways, the apotheosis of great palliative care.” And I believe that to be true. When you think about the early concepts that shaped the field, you can see how palliative care for persons experiencing homelessness fits like a hand in a glove: total pain envisioned by Cicely Saunders, which even its earliest sketches included social suffering like loneliness; or Balfour Mount, who coined the term “palliative care,” lamenting the cruel irony of our care for the dying, and the desperate need to create programs to reach more people experiencing suffering.
Today we talk with Naheed Dosani, a palliative care physician at St. Michael’s Hospital in Toronto, and health justice activist. His story, which he shares on today’s podcast, is remarkable. Just out of fellowship, Naheed built a palliative care program for homeless persons called the Palliative Education and Care for the Homeless (PEACH) Program. This podcast is a complement to our prior podcast on aging and homelessness with Margot Kushel. Today we discuss:
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What is the best terminology? Homeless? Homelessness? Houseless? Marginally housed?
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What makes palliative care for people experiencing homelessness challenging? What makes it rewarding?
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What is unique about the practice of palliative care for people experiencing homelessness? We discuss the principles of harm reduction, social determinants of health, and trauma informed care. Major overlap with substance use disorder issues, which we have covered recently (and frequently) on this podcast.
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How are the health systems designed or not designed to meet the needs of people experiencing homelessness?
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What are the equity issues at stake, and at risk of being cut, both in Canada and the US?
Many more links below. And I had a blast playing Blinding Lights by that Toronto band The Weekend.
Enjoy!
-Alex
End Well Talk
https://www.youtube.com/watch?v=eG4QE-hfPQU
Resources on the PEACH Program
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Program Review Paper – A recent publication in Longwoods Healthcare Quarterly reviewing the PEACH model.
https://pubmed.ncbi.nlm.nih.gov/37144698/ -
Promising Practice Recognition – PEACH was named a Promising Practice in equity-oriented palliative care as part of a national initiative funded by Health Canada, operated by Healthcare Excellence Canada & the Canadian Partnership Against Cancer.
https://www.healthcareexcellence.ca/media/z3jifqqd/pp-peach-en-2024-v2.pdf -
CityNews Toronto Feature
https://toronto.citynews.ca/2022/08/08/peach-team-palliative-health-care-homelessness/
Psychosocial Interventions at PEACH
In addition to medical care, PEACH also runs two key psychosocial interventions for our clients:
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PEACH Grief Circles – Structured spaces for workers in the homelessness sector to process grief. CBC covered this a few years ago, including a radio segment feature on CBC White Coat, Black Art (which you can access at the below link).
https://www.cbc.ca/radio/whitecoat/palliative-care-team-helps-the-homeless-die-with-dignity-a-healing-circle-helps-them-grieve-1.5048409 -
PEACH Good Wishes Program – A program that provides meaningful gifts for unhoused individuals who are terminally ill.
https://www.cbc.ca/news/canada/toronto/toronto-homeless-palliative-holidays-1.5407360
Kensington Hospice & 'Radical Love' Equity-Oriented Hospice Palliative Care
Naheed Dosani also serves as the Medical Director of Kensington Hospice, Toronto’s largest hospice. There, he helps run an innovative program called 'Radical Love' Equity-Oriented Hospice Palliative Care, which provides low-threshold, low-barrier access to hospice care for structurally vulnerable individuals (e.g., those experiencing homelessness). The program also operates via a partnership with the PEACH Program.
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As a result of the 'Radical Love' program at Kensington Hospice: At any given time, Kensington Hospice has evolved from caring for structurally vulnerable individuals <2% of the time...to now serving structurally vulnerable people 40–50% of the time.
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Canadian Press Feature – A powerful and widely shared piece on our work.
https://www.cbc.ca/news/canada/toronto/ont-homeless-palliative-1.6901396 -
Promising Practice Recognition – Kensington Hospice’s Radical Love program was also recognized as a Promising Practice by Healthcare Excellence Canada & the Canadian Partnership Against Cancer.
https://www.healthcareexcellence.ca/media/gxmf021n/pp-kensington-hospice-en-2024-v3.pdf
National Canadian Efforts in Equity-Oriented Palliative Care
Canada is investing in equity-oriented palliative care through the Improving Equity in Access to Palliative Care (IEAPC) Collaborative. This is a multi-year funded initiative that supports 23 equity-oriented palliative care models for people experiencing homelessness and structural vulnerabilities across Canada.