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Blog posted by: Niamh Brophy, Monday, 12 November 2018.

There are huge challenges for staff working in the homelessness sector when it comes to providing palliative care, including a lack of appropriate services and dealing with the additional emotional pressures. 

In this blog, Naimh Brophy, Palliative Care Coordinator at St Mungo’s explores the issues.

For years I have observed people who are experiencing homelessness facing extreme inequality and exclusion in relation to their health and social care. The irony, of course, is not lost here. These very individuals who are the least likely to receive adequate care, are the ones who need it most.

We all know the numbers by now. People experiencing homelessness are much more likely to be living with chronic illnesses and suffer from multiple needs. When these illnesses go untreated and you add other complexities to the mix, people die younger, in fact 30 years younger, than the general population. 

Lack of appropriate options 

In London alone, there are likely to be hundreds of people living on the streets, in hostels or supported housing who are at risk of dying due to their advanced ill health. When speaking with these people I hear stories of them feeling alienated from services, let down and lacking in trust of the health professionals who are tasked with caring for them. This often results in people not accessing health care until very late in their illness, with care being crisis led.

Research has confirmed that many people remain in hostels as their health deteriorates, and do not receive support from palliative care services as their illness progresses. For many this will be because mainstream health and social care services struggle to meet the needs of this client group. For example, they may be excluded from services based on their young age, substance use issues, or behaviour that is perceived as ‘challenging’. This leaves them with no other option but to remain in their hostel or supported housing as their health deteriorates. For others, it may be their choice to remain in their hostel as it is the only place they have considered home for a long time.

Challenges for homeless sector staff 

For homelessness staff supporting these individuals they have a heavy burden to carry. Daily, I witness staff going above and beyond their roles in order to support someone whose health is a serious concern, working tirelessly in such stressful situations they perhaps never thought they would ever find themselves in. After all, we are supposed to be working in ‘recovery’, not end of life.

These emotional and practical challenges are compounded by the fact that homeless sector staff do not receive adequate training to support residents whose health is a serious concern, and often in-reach support from health and social services is inadequate at these times when they are needed most. Questions I hear often include ‘How do we identify who may be dying?’ ‘How do I initiate difficult conversations about death and dying?’ ‘What do we need to consider when planning care in a hostel environment?’ ‘Who can help us?’

Solutions 

It is clear that these issues are a challenge to staff providing support in the homelessness sector. To help answer these questions we have developed a new Palliative Care Training course. This one-day introductory course is designed to support frontline staff working in the homelessness sector so they will feel more confident and knowledgeable when faced with supporting clients with serious health concerns. The course covers key issues like identifying clients who need additional support, communicating about deteriorating health, and legal and ethical considerations surrounding palliative care for this client group. Although the course is focused on client issues, we recognise the impact these experiences have on staff and teams and focus on self-care and staff wellbeing throughout the day.

Find out more about Homeless Link's Palliative Care Training course here. 

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