Background To improve advance care planning and palliative care for severely ill homeless people, insight into current practice is required. Therefore, the present study aims to describe the characteristics of people who deceased after having been homeless, the care preferred and received at the end of life, and difficulties in medical decision-making at medical respite shelters.
Methods We conducted a quantitative and qualitative retrospective record review at two Dutch medical respite shelters. Included were the medical and nursing records of 61 homeless clients who were known to be deceased between 2009 and 2016 and had resided in one of both shelters for at least one night in the three months before death.
Results The large majority of patients had a combination of somatic (98%), psychiatric (85%) and substance use problems (93%). Discussions about imminent death were reported for 75% of the patients for whom it was recognized. Twenty-six percent of records provided information about patients’ preferred place of death, which mostly was the shelter. For 36% of patients, hospital admissions had been considered undesirable by their clinician(s). In the three months before death, 75% of patients had at least one such admission. Documented difficulties in medical decision-making mainly concerned impaired decisional capacity of patients, language barriers, and fragmentation and discontinuity of care.
Conclusion At the end of life, homeless people suffer from multiple health-related problems that require specific expertise. They experience multiple, often undesired hospital admissions. This could be avoided by more comprehensive collaboration between psychosocial, medical, and palliative care.
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