Hospice care is intended to provide a compassionate, home-like environment for people near the end of life – but for many structurally vulnerable individuals, accessing community-based hospice remains difficult or impossible.

People experiencing homelessness, poverty or substance use often face stigma and exclusion in healthcare settings—especially near the end of life. While hospice care is designed to offer dignity and comfort, many programs may lack the policies, resources, or frameworks needed to serve structurally vulnerable populations.

About the study

This study explores how hospices across Ontario are thinking about and responding to barriers that people who use drugs or face structural marginalization, may encounter when seeking hospice palliative care services. It explores how hospices are navigating these challenges and can help inform conversations about how to improve access, support staff and build more inclusive models of palliative care.

Methods

We’re interviewing leaders at residential hospices across Ontario about their admission practices and decision-making. The study focuses on three main areas:

• Whether structural vulnerability is considered in admissions decisions
• Whether people who use drugs—especially those who inject—are admitted
• What supports are available to help provide care for these populations.

We’re analyzing the responses using both descriptive statistics and qualitative methods to map out current practices and identify common barriers or challenges.

Impact

We hope this research will help policy makers, hospice leaders, and health system planners understand the barriers that prevent structurally vulnerable populations—especially people who use drugs—from accessing hospice care. The findings could inform the development of clearer, equity-focused policies, improve training for staff, and support hospices in adapting their models to better serve marginalized communities.

By highlighting both the challenges hospices face and the opportunities for change, this study can contribute to broader health system conversations about inclusion, stigma and structural reform in end-of-life care.