Background Many people who are homeless experience poor health. 41% have long term health issues, including a mix of mental and physical poor health and substance misuse (Homeless Link, 2014). Death often occurs early and symptom burden at end of life is heavy. Access to palliative care is limited (Shulman, Hudson, Low et al., 2018). Those least able to advocate for themselves are most often overlooked (Care Quality Commission, 2017).

Aims By working in collaboration with others, to bring choice and access to palliative and end of life care for local people who are homeless. To ensure barriers to care are removed and homeless individuals and their supporters are not overlooked.

Methods Monies obtained from the Rayne Foundation. One homelessness lead employed one day a week and two experienced counsellors for three hours a week each. Education to local hostels and ongoing support maintained by visits, phone calls and referrals. Collaboration with housing and social care, local voluntary organisations, hospitals and discharge team. Teaching around homeless heath and end of life care to final year nursing students. Hospice provides bed at end of life and Day Hospice welcomes people who are homeless in to services. Links with other hospices setting up similar projects. Dissemination of learning through conferences, presentations and engaging with media (e.g. Radio 4). Individual case work, and counsellors provide emotional and psychological support around loss and grief flexibly across the geographical footprint.

Results Excellent relationships with local hostels which are better able to support residents. Less secondary and more primary care. Individuals now accessing Day Hospice, Macmillan nurses and planning for their future care. Place of death honoured for three individuals (two in hospice and one in hostel). Hospice supporting other hospices with similar projects.

Conclusion In collaboration with others and several different approaches, the hospice is able to offer choice and access to care for the homeless population it serves; therefore transforming experience for this marginalised group.