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Walsh, J. J., Sussman, T., & Canham, S. L. (2026, Oct). "We're actually challenging the definition of hospice care": Policies and practices in hospice palliative care for older people experiencing homelessness. [Paper presentation]. The 55th Annual Scientific and Educational Meeting of the Canadian Association on Gerontology, Charlottetown, PEI, October 15-17, 2026.

Abstract

Despite the adage 鈥渄eath is the great equalizer鈥�, mainstream hospice palliative care services are designed in ways which exclude older people experiencing homelessness (OPEH). OPEH at the intersection of multiple oppressions face additional barriers; colonial violence positions mistrust as a substantial barrier for Indigenous OPEH, while expectations of abstinence exclude OPEH who use drugs. In response, several specialized hospices have emerged across Canada using equity-oriented approaches and built environments to extend hospice care to this population. Yet we know little about the ways equity-oriented hospices resist exclusionary, colonial systems of care and the tensions arising when equity-oriented practices challenge taken-for-granted assumptions about what constitutes good end-of-life care across the hospice system. This presentation draws on 26 semi-structured interviews with hospice workers at seven equityoriented Canadian hospices. Informed by a concurrent mixed methods approach, we analyzed the interviews alongside fieldnotes from on-site observations, document reviews, and hospice resident demographics to meet our study aims. Our analysis revealed three core tensions: optimizing quality-of-life in social precarity, addressing substance use in abstinence-oriented systems, and incorporating Indigenous culture practices in colonial institutions. While hospices challenged social inequities producing and exacerbating life-limiting illnesses and resisted exclusion of OPEH, our analysis also revealed these hospices experienced resistance from mainstream assumptions centring biomedical, colonial, and moral stances in hospice care. A reciprocal relationship emerged whereby equity-oriented approaches resisted normative assumptions, while normative assumptions, at times, limited equity-oriented approaches and built environments. Recommendations for improving equity-oriented hospices鈥� capacities for delivering end-of-life care to OPEH will be discussed.