This outreach program in Thunder Bay, Ont., aims to help homeless people with life-limiting illnesses

As an outreach worker helping people with life-limiting illnesses in Thunder Bay, Ont., Julie Diner says she doesn't spend much time in the office.

"Some days, I'm taking clients to the cancer clinic for chemotherapy. Other days, I'm at tent city looking for a client, so that I can let them know their ID came in," she said. "Or maybe I'm delivering some toilet paper to someone in need; my days are all over the place."

Diner is the only outreach worker with the Palliative Advocacy and Care Team (PACT). The program is led by Hospice Northwest and NorWest Community Health Centres (NWCHC) in partnership with several other organizations. 

Those involved conduct virtual rounds with vulnerably-housed clients to assess their needs for health care and social services. Diner's job is to make sure they get from Point A to Point B and provide support along the way. 

As someone in recovery from alcoholism and addiction who was formerly homeless herself, Diner said her lived experience helps her connect with clients.

Some days, I'm taking clients to the cancer clinic for chemotherapy. Other days, I'm at tent city looking for a client, so that I can let them know their ID came in.- Julie Diner, outreach worker at PACT

She remembers living at Shelter House when she needed to have her gallbladder removed. Complications resulted in it being a major surgery.

"Trying to cope with that and [an] infection while living at the Shelter House was very intense, in pain, all the things that you can imagine," she said.

"I understand what it's like to live on a mat at the shelter. I understand what it's like to live in a tent down by the river … those experiences help me build relationships and build trust."

PACT receives funding from NWCHC as well as Healthcare Excellence Canada, a not-for-profit charity primarily funded by Health Canada. There are currently between 35 and 40 clients.

However, the money from Healthcare Excellence Canada is a pilot project that's expected to end soon, which means the team is seeking alternative options to keep the program going, with hopes of expanding it further.

'Homelessness is a terminal diagnosis'

Donna Jeanpierre is executive director of Hospice Northwest. She says PACT was formed in 2019, following the release of a needs assessment by Dilico Anishinabek Family Care the year before called Palliative Care for Vulnerable and Underserved Populations.

Following that, as well as a visit from palliative care physician and health justice activist Dr. Naheed Dosani of Toronto, local organizations began to look into how to address the gaps for those struggling to access palliative or end of life care, Jeanpierre explained.

"Dr. Naheed Dosani did say homelessness is a life-limiting illness and homelessness is a terminal diagnosis," said Jeanpierre. "That can make it challenging to follow through with appointments or have access to transportation to get to appointments — even having a phone to confirm an appointment."

At least 550 people are known to be experiencing homelessness in Thunder Bay, according to the latest point-in-time count done in the fall. About 37 per cent of those surveyed said they were experiencing an illness or medical condition, while more than half reported being treated unfairly in a health-care setting.

Jeanpierre wants to see the PACT program expand with more than one outreach worker, a nurse practitioner and a co-ordinator, "because it is a lot of work to follow-up on people that don't have telephones and fixed addresses."

"We'll be looking to find funding to make sure this work continues," Jeanpierre said.

CBC News reached out to Healthcare Excellence Canada and asked whether funding for PACT would be extended. Kristine Russell, manager of communications, said that "the program is scheduled to end March 2026."

Hopes for program expansion

In less than two years, Diner said she's seen clients complete their cancer journeys and meet other key milestones.

"I truly believe that if my position wasn't here and the PACT team didn't exist, those people would not have been able to get completed the treatments they needed," Diner said.

"This bridging the gaps between people who are homeless and health care is huge."

If the sky was the limit, she said, she'd want to see more outreach workers, a program co-ordinator, a full-time nurse and palliative carer doctor, a low-barrier hospice in town, and wheelchair-accessible vans to transport clients.

"I want to see it grow," Diner said. "We need it. We really need it."