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• W2078332564 abstract "One of the main themes of the 2006 World Hospice and Palliative Care Day was to ensure ‘access for all’ and over 75 countries including the UK took part in the celebrations. This remains a welcome goal as it reiterates the view held in palliative care settings that everyone has a right to high quality end-of-life care. Most people come from family homes into palliative care facilities, and there is documented evidence (Gomez et al, 2011) that most people prefer to die in their own homes. In that case, facilities and services are brought to their homes to enable their wishes. While efforts are being made to ensure such preferences and access for black and minority ethnic groups, the needs of other vulnerable groups such as travellers, prisoners and homeless people require extra commitment from palliative care service providers. The profile of homeless people suggests their symptoms may not always be cancer-related, but may include liver failure due to alcohol abuse, HIV/AIDS, and self-neglect (St Mungo’s, 2004). With liver failure, jaundice is the overt symptom to look for, together with capsular pain. The work of St Mungo’s (2004) together with Marie Curie hospice services highlighted how homeless people tend to present with spontaneous bleeding, low mood, social isolation and self-harm/neglect, which may suggest a perceived lack of purpose in life. Judging by the continued presence of homeless people, it makes sense to conclude we have failed to eradicate the causes of homelessness, which makes the argument for their accessing palliative care more important. But it must be acknowledged that homeless people and the nature of their profile pose a challenge for accessing palliative care services., for example, where they live (on the streets or temporary unsuitable accommodation), communication issues or tensions with health professionals, stigma and prejudice they may experience. GPs and community nurses may not always register and visit them on the streets. Unlike younger homeless people, whose numbers are well documented (Warnes and Crane, 2000), older homeless people are not well accounted for. Warnes and Crane (2000) report on an analysis of the Hansard which showed less than 1% of items on older homeless people, compared to 24% on young homeless in the same period. The lack of statistical evidence may also suggest low priority being given to their plight. Conversely, it may suggest the complexity of identifying the homeless, rough sleepers or missing persons. Homeless people over 50 tend to be invisible as they often stay hidden away from public view. Definitions of homeless do not help, as the suggestions point at those over 50, sleeping rough and/or living in temporary/inappropriate accommodation, and even those at risk of imminent homelessness. Because of their profile, homeless people might benefit from specially designed caring services embedded in the palliative care philosophy, with a focus on the psychology of homelessness and the lifestyle and street families network inherent in their life. The preference for dying at home seems to work better when the patient has a supportive family or friends. With a homeless patient, the ideas of discharge and home visits need reviewing. A coordinator role, which has worked well at St Mungo’s hospice, might be crucial across the country. And lessons could be learnt from joint-working between St Oswald’s Hospice and Macmillan Cancer Support when they collaborated with Northumberland Tyne and Wear NHS Trust to develop a specific service for people with learning disability approaching the end of life. Doing it this way means that homeless people can be afforded access to palliative care services without restrictions on their lifestyles and behaviours, often found in hospitals. If effective palliative care is to be delivered to homeless people, health professionals within the field must have further awareness of the complexities inherent in being homeless, for example, a high mortality rate, which suggests prompt decisions and immediate intervention are important. In addition, homeless people tend not to have surrogate decision-makers and health professionals may end up acting in their ‘best interest’. With that in mind, palliative care training should be offered to staff in hostels and other temporary accommodation. Collaboration with community nurses working in palliative care settings about homeless people should also be encouraged. Politicians must provide extra funding to hospices and other palliative care settings to enable this. Homeless people approaching end of life can be supported to enhance their quality of life, albeit briefly. Services that recognise the complex symptoms and lifestyle inherent within homelessness should be supported. BJCN" @default.
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• W2078332564 date "2012-10-01" @default.
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• W2078332564 title "Is there room at the inn? Palliative care for the homeless" @default.
• W2078332564 doi "https://doi.org/10.12968/bjcn.2012.17.10.473" @default.
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