When Dr. Naheed Dosani pointed out in 2016 that people experiencing homelessness were being left out of hospice care at Kensington Health, Nadine Persaud saw both a crisis and an opportunity. Together, now as Medical Director and Executive Director at the Hospice and Palliative Care Program at Kensington Health respectively, they have set out to transform the program into one that welcomes everyone – no matter their circumstances. 

Building Care That Meets People Where They Are 

There was no question that the Hospice and Palliative Care Program was clinically excellent, but was it equitable? The duo decided to conduct a survey to collect sociodemographic data. "The data was very telling,” Persaud says. “It revealed that hospice access overwhelmingly favoured individuals who were white, housed, and living with cancer,” 

This realization fueled a bold reimagining of what equitable and accessible hospice care could look like. “We began prioritizing social determinants of health alongside medical need, asking questions like, 'Does this person have food security?’ ‘Do they have a support system?’ ‘Do they have a home?’” Persaud highlights. 

To meet those needs, the Hospice and Palliative Care Program at Kensington Health appointed physicians with experience in providing equity-oriented palliative care in various settings, brought in one of Ontario’s first hospice-based nurse practitioners, and built partnerships with shelters, inner city hospitals and street-based outreach programs like the PEACH (Palliative Education and Care for the Homeless) Program. No longer were they “standing by the fax machines,” waiting for referrals, says Persaud – they were going directly into the community to meet people where they are at.  

The philosophy behind these changes became known as Radical Love, a program that provides low-barrier access to hospice care for structurally vulnerable individuals. Inspired by a keynote from Dr. Dosani, reframing compassion as an active choice, Radical Love calls for care rooted in equity and empathy. “The clients I cared for on the streets and in shelters couldn’t get access to hospice palliative care before this program started. Now they can. That’s what radical love is – it’s our response to addressing inequities in health for those in need of palliative and end-of-life care,” says Dr. Dosani. For him, he’s proud to see healthcare organizations, like Kensington Health, “not just talking the talk”, but “walking it.” 

Transforming Hospice, Inspiring Change 

The results have been profound. Before Radical Love, fewer than two percent of hospice admissions came from structurally vulnerable populations. Today, 40 to 50 percent of the Hospice and Palliative Care Program at Kensington Health’s clients reflect these communities. The program also pioneered Canada’s first peer-worker initiative in a mainstream hospice, embedding people with lived experience into the care team to foster trust and belonging. As Persaud reminds us, “when working with this population, you don’t just need the trust of clients – you need the trust of the whole circle of care.” 

Perhaps most surprisingly, this model has led to outcomes that some say may even challenge conventional expectations of hospice care. Roughly 1 in 5 clients are discharged from hospice with improved health and ongoing supports, thanks to continuity of care from PEACH and the Second Mile Club. “When someone finally has access to shelter, food, and healthcare –after years without it– it’s no surprise they begin to heal,” says Dr. Dosani. 

The program’s success has earned international recognition, including the “Hospice Innovation Award” in 2024 from the Hospice Palliative Care Ontario and invitations to deliver a keynote address, pre-conference training & workshops at the National Health Care for the Homeless Conference in Baltimore, Maryland. “Being invited to share our work on international stages reflects something bigger,” says Dr. Dosani. “It shows that equity-oriented hospice care isn’t just possible – it’s necessary.”

Want to learn more about Radical Love and the Hospice and Palliative Care Program at Kensington Health? Click here.