Advanced ill health and homelessness: a complex issue

8 May 2017 11:52 AM

Blog posted by: Niamh Brophy, Friday, 5 May 2017.

Although the link between homelessness and health is widely recognised, our understanding of the experiences of homeless people dying on the streets, in hostels or in hospital remains poor. 

What we do know is that physical health problems can be both a cause and consequence of homelessness. People experiencing homelessness have a much higher likelihood of having a long-term health condition, yet a reluctance to engage with health services means illnesses often go undetected and untreated over time. Substance use and poor mental health can further compound these issues, with care often being crisis led.

When speaking with homeless people you hear of incidents that caused them to feel isolated and let down by services. For others negative experiences led them to lose trust in professionals, feeling stigmatised or discriminated against. A consequence of this ‘non-engagement’ is demonstrated most shockingly in the statistic for average age of death: 47 for men, 43 for women (3).

It should not come as a surprise to hear that most homeless people do not gain access to palliative care until very late in their illness, if at all. Little time is ever given to identifying their preferred place of care, or expressed wishes for the end of their life. Often their choices for care are limited, and their death is more likely to be perceived as sudden, untimely and undignified (3).

St Mungo’s Palliative Care Service

Since 2007, St Mungo’s has worked to address these issues and improve care services for residents with advanced ill health. The aim of the service is to give those with serious health concerns the opportunity to choose their treatment, the chance to reconnect with loved ones, and the possibility to die in a dignified, comfortable way in a place of their choosing. We do this in five different ways:

• Support residents to make informed choices about future needs and wishes and ensure access to supportive services, including specialist palliative care;
• Support residents and staff in dealing with the psychological and emotional aspects of approaching the end of life;
• Provide appropriate training to frontline staff in dealing with end of life issues, including bereavement support and spotting when clients may be at risk of dying;
• Provide bereavement support to frontline staff and residents through a volunteer-led bereavement befriending service;
• Work in partnership to raise awareness of the end of life care needs of people who are homeless.

Since its inception, St Mungo’s has demonstrated the following results:

• Over 190 residents have been provided with end of life care support including bereavement support. This created opportunities for residents to stay longer at home, feel supported emotionally, as well as allowing them the opportunity to make their wishes and preferences known.
• Over 300 staff have received training about homelessness and end of life care, including training sessions tailored to the specific needs of individual projects. This has enabled staff to feel more confident in identifying those who may benefit from support.
• An on-line Resource pack has been developed aimed at supporting staff working with homeless people.
• Forged greater links and partnership working with services e.g. a multidisciplinary working group set up to identify earlier on those residents whose health may be deteriorating. This involves the local alcohol service, GP, hostel and hospice staff and is chaired by the Palliative Care Coordinator.
• Collaborative research with UCL, Marie Curie and Pathway and training development that explores the challenges of palliative care for homeless people and how best to overcome them.

It is clear that providing end of life care for homeless people brings unique challenges. No one service can be expected to meet the needs of someone dying in a hostel or on the streets. These challenges can only be overcome by taking a multi-disciplinary approach: health, social, housing, mental health, drug and alcohol services working together to plan for, and address the multiple and complex needs of homeless people, as they reach the end of their lives. In the UK, we provide the best end of life care in the world (4). We must work to ensure this best practice is extended to all members of our society; particularly those vulnerably housed who all too often fall through the cracks.

For more information, please contact Niamh Brophy, Palliative Care Coordinator Niamh.brophy@mungos.org or 07776468214

References

1. O’Connell, J.J., December (2005).  Premature Mortality in Homeless Populations: A review of the literature; National Health Care for the Homeless Council
2. St Mungo’s (2010), Homelessness, it makes you sick: London Pathways: Health Standards
3. Thomas, Bethan (2012) Homelessness Kills. Crisis Report.
4. Quality of Death Index (2015), Economist Intelligence Unit.