PC for People Experiencing Homelessness: Naheed Dosani
GeriPal - A Geriatrics and Palliative Medicine Podcast
Release Date: 03/06/2025
We Need a Care Revolution: Victor Montori
GeriPal - A Geriatrics and Palliative Medicine Podcast
In his book, “,” Victor Montori decries the industrialization of healthcare. We’ve become a healthcare factory, beholden to health systems motivated by profit. In particular, he laments the loss of the “care” aspect of healthcare. Clinicians are under the clock to churn through patients. Patients are tasked with doing work outside of the clinic. Patients are tasked with hours and hours of work to self manage, obtain and manage medications, track weights and fingersticks, not to mention scheduling visits and waiting around for the visit to start. Now we have an app for...
info_outline
System Wide Goals of Care Implementation: A Podcast with Ira Byock, Chris Dale, and Matt Gonzales
GeriPal - A Geriatrics and Palliative Medicine Podcast
Most health care providers understand the importance of goals-of-care conversations in aligning treatment plans with patients’ goals, especially for those with serious medical problems. And yet, these discussions often either don't happen or at least don't get documented. How can we do better? In today’s podcast, we sit down with Ira Byock, Chris Dale, and Matthew Gonzales to discuss a multi-year healthcare system-wide goals of care implementation project within the Providence Health Care System. Spanning 51 hospitals, this initiative was recently described in NEJM Catalyst, showing truly...
info_outline
Death Anxiety: Dani Chammas & Keri Brenner
GeriPal - A Geriatrics and Palliative Medicine Podcast
What is death anxiety? We spend the first 15 minutes of the podcast addressing this question. And maybe this was unfair to our guests, the fabulous dynamic duo of palliative psychiatrists Dani Chammas and Keri Brenner (listen to their prior podcasts on and the ). After all, we invited them on to our podcast to discuss death anxiety, then Eric and I immediately questioned if death anxiety was the best term for what we want to discuss! Several key points stood out to me from this podcast, your key points may differ: The “anxiety” in “death anxiety” is not a...
info_outline
Individualizing Blood Pressure Goals in Older Adults: A Podcast with Mitra Jamshidian, Simon Ascher and Mark Supiano
GeriPal - A Geriatrics and Palliative Medicine Podcast
What’s the ideal blood pressure target for older adults with hypertension? Should we aim for a systolic BP of 120 mmHg in all older adults, as suggested by the ? Or should we be more flexible—especially for those who are frail or among the oldest old? This week on the GeriPal Podcast, we explore the nuances of managing blood pressure in older adults with our guests Dr. Mark Supiano, Dr. Mitra Jamshidian, and Dr. Simon Ascher. Now, some of our astute GeriPal listeners may say, “wait, didn't you already talk about this with Mark Supiano in a 2017 podcast titled ” Yes, we sure...
info_outline
Should Palliative Care be in the Survivorship Business? A Podcast with Laura Petrillo, Laura Shoemaker
GeriPal - A Geriatrics and Palliative Medicine Podcast
In this week’s episode, we dig into two deceptively simple questions: When does someone become a cancer survivor, and should palliative care be in the business of caring for them? Spoiler: It’s more complicated than it seems. We’ve invited two palliative care doctors to talk about survivorship with us: , a physician-researcher at Mass General Hospital and Harvard Medical School, and , an outpatient palliative care doctor at the Cleveland Clinic. This episode is a must-listen for those navigating the evolving landscape of cancer care, and asking not just how we treat cancer, but how we...
info_outline
Health and Wealth Shocks: Lauren Hunt, Rebecca Rodin, Tsai-Chin Cho
GeriPal - A Geriatrics and Palliative Medicine 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...
info_outline
Transgender Health, Aging, and Advocacy: A Podcast with Noelle Marie Javier and Jace Flatt
GeriPal - A Geriatrics and Palliative Medicine 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...
info_outline
What You Should Know About Radiation Oncology: A Podcast with Anish Butala, Emily Martin and Evie Kalmar
GeriPal - A Geriatrics and Palliative Medicine 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, ,...
info_outline
Implementing Palliative Care in Nursing Homes
GeriPal - A Geriatrics and Palliative Medicine 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...
info_outline
Lucid Episodes: Andrea Gilmore-Bykovskyi & Andrew Peterson
GeriPal - A Geriatrics and Palliative Medicine 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...
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:
-
What is the best terminology? Homeless? Homelessness? Houseless? Marginally housed?
-
What makes palliative care for people experiencing homelessness challenging? What makes it rewarding?
-
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.
-
How are the health systems designed or not designed to meet the needs of people experiencing homelessness?
-
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
-
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:
-
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.
-
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.
-
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.