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People experiencing homelessness are at increased risk for illness and mortality and face significant systemic barriers to receiving good palliative care at the end of life. While there is some research demonstrating that health navigators can improve the health care of underserved patients, there is are no research demonstrating the impact of a professional health navigator in community-based palliative care for
individuals experiencing homelessness.
This study by Robinson and colleagues (2022) sought to quantify the impact of a health navigator on the delivery of palliative care to patients experiencing homelessness through the Palliative Education and Care for the Homeless (PEACH) Program in Toronto.
A health navigator is a healthcare professional or peer who specializes in coordination of care, case management,
navigating healthcare transitions, and reducing barriers to care. The PEACH Program established a health navigation role at the beginning of the COVID-19 pandemic and hired an individual with Master of Social Work preparation.
This service evaluation study included the development of unique key performance indicators (KPIs) that were categorized into one of two domains: (1) palliative care for people experiencing homelessness (including KPIs related to housing, income, and food insecurity) and (2) general community- and home-based palliative care (e.g. “mainstream” palliative care). Activities and outcomes associated with each KPI were tracked by the PEACH health navigator. The total number of times each individual KPI was achieved as well as the frequency of occurrence per KPI category were calculated.
In a one year period between July 2020 and July 2021, a total of 407 activities were logged by the PEACH health navigator. More than half (207) of the activities were related to providing palliative care to people experiencing homelessness, while the remaining 200 activities were related to “mainstream” palliative care. The authors identified five key areas of the health navigator role including (1) facilitating access (2) coordinating care (3) addressing social determinants of health (4) advocating for patients, and (5) counselling patients and loved ones.
The authors concluded that incorporating a professional health navigator into community-based palliative care teams improves access to care for structurally vulnerable populations.
Source: Robinson, L., Trevors Babici, L., Tedesco, A., Spaner, D., Morey, T., & Dosani, N. (2022). Assessing the impact of a health navigator on improving access to care and addressing the social needs of palliative care patients experiencing homelessness: A service evaluation. Palliative Medicine, 02692163221146812.
