Background People experiencing homelessness have the worst health outcomes in society (Aldridge, Story, Hwang, et al., 2018), with the least access to services (Bureau of Investigative Journalism, 2018). They often have a tri-morbidity of issues (Dorney-Smith, Schneller, Aboim, et al., 2018); mental health substance use and physical health issues (Rae, Rees, 2015). People experiencing homelessness die 30 years before the general population; often suddenly with no access to palliative care (Webb, Mitchell, Snelling, et al., 2020).
Aims To open up palliative care by upskilling staff and to facilitate closer working between palliative care and the homelessness sector to break down barriers.
Methods Development of key relationships with agencies and organisations to support multi-agency working through the provision of education with particular focus on palliative care and advance care planning.
Results Initial findings show that advance care planning within this timeframe is not achievable in this cohort. Issues around gaining trust and bad experience with health professionals have been a barrier to this. The mean age of patients is 40, so there is an element of fear and denial when discussing end of life due to young age. Barriers to multi-agency working can be broken down through delivering education. An assertive outreach model is effective for this cohort. Gaining trust is time consuming, but worthwhile in terms of positive outcomes.
Conclusion Sudden deaths do occur and the presence of longer term chronic conditions with no clear disease trajectory means deaths are often unexpected and occur without a care plan in place. Early intervention at the point of deterioration of physical health as a trigger for referral, as opposed to last weeks/days of life is more effective when working with this cohort.
People experiencing homelessness are not hard-to-reach but unfortunately, are easy to ignore. By advocating for trauma-focused commissioning and identifying gaps in provision to highlight these inequalities, it is our shared responsibility to open up palliative care to all.
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