Background Qualitative data shows people experiencing homelessness worry about their death, where they will die, and fear lack of support with symptom control and healthcare provision due to previous experiences (Song, Bartels, Ratner, et al., 2007. J Gen Intern Med. 22: 435; Ko, Kwak & Nelson-Becker, 2015. Death Stud. 39: 422; Krakowsky, Gofine, Brown, et al., 2012. Am J Hosp Palliat Med. 30:268). Identified barriers to accessing palliative care for people experiencing homelessness include late recognition of ill-health, unpredictable disease trajectory, complexity of care, delivery of palliative care in the hostel setting and inflexibility of mainstream services (de Veer, Stringer, van Meijel, et al., 2018. BMC Palliat Care. 17; Hudson, Flemming, Shulman et al., 2016. BMC Palliat Care. 15).
Aims To observe whether the introduction of a joint Homeless-Palliative Care Multidisciplinary Team (HPC-MDT) could engage people experiencing homelessness with advancing ill-health and provide accessible interventions.
Methods Two years ago, a new HPC-MDT was formed including GPs with a specialist interest in homeless healthcare, Homeless Outreach Nurses from a GP practice providing specialist homeless care and Consultants in Palliative Medicine from a local hospice. An audit has been carried out to observe the number of interventions provided for people experiencing homelessness who have died of an expected death and the number of interventions provided to those who are on the current HPC-MDT caseload.
Results During the two-year audit, there were 20 expected deaths; of those 18 received some form of palliative care input. There are 13 individuals who are currently active on the HPC- MDT caseload. The most common interventions by the HPC-MDT were regular GP assertive outreach (24 patients) and joint HPC-MDT outreach (15 patients). A further 8 patients were reviewed by hospice Allied Healthcare Professionals, four patients received care in a hospice in-patient unit and two rapid palliative discharges from hospital were supported. On three occasions the HPC-MDT supported the use of a syringe driver for symptom control in the hostel setting.
Conclusion The provision of an HPC-MDT increases engagement of people experiencing homelessness with palliative care in all settings. Collaborative and multi-professional working makes interventions for people experiencing homelessness possible at the end of their lives.
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