Table 2 Challenges and suggestions for the provision of palliative and end of life care to people who are homeless
Codes | Challenges to the provision of palliative and end of life care | Suggestions for the provision of palliative and end of life care |
|---|---|---|
Challenges related to the chaotic lifestyles associated with being homeless | ||
Death in the day to day context of homelessness | Previous negative experiences of death and fear of death | Peer advocates/community services to facilitate attendance & engagement |
Unconventional living arrangements & social isolation | Training for staff around addiction issues and associated complications | |
Attitudes to health care; substance misuse & competing priorities | Previous negative experiences or perceptions of health care & mistrust of professionals | |
Poor engagement with services | ||
Substance and alcohol misuse | ||
Complex care needs & competing priorities | ||
Trends in accessing health care and poor adherence to treatment | ||
Communicating about death, dying and advance care planning | ||
Challenges to the delivery of end of life care and specialized palliative care within a hostel | ||
The hostel environment | Limited resources | Advocacy |
Difficulty accessing support and specialist services | Greater collaboration with medical services – MDT discussion | |
Limited medical information | Greater in hostel support from medical and social services | |
Practical and emotional burdens for staff | Limitations of staff roles | Increased training & specialised services |
Emotional burden for staff | ||
Challenges to the provision of palliative care to homeless persons relating to mainstream health care systems | ||
Inflexibility of the health care service and limited planning | Inflexible services and systems | Flexibility in care model & locations |
Strict rules and regulations | Harm minimisation strategies | |
Lack of specialised services | Linking with community services | |
Limited planning, especially at discharge | Training for health care professionals | |
Health care professionals’attitudes and inexperience in supporting homeless people | Attitudes of professionals | Person centred care |
Emotional & practical burdens | Increased training & specialised services | |