End-of-life care for people who are homeless

Chloe Longmoreby Chloe Longmore
Service Design Manager

Following on from the publication of our resource pack, the innovative Marie Curie and St Mungo’s partnership held an “End-of-life Care for People who are Homeless” event on 18th June.

The event was the first of its kind, bringing together a wide variety of stakeholders working in public health, NHS England, homeless projects, acute trusts, commissioners and many other areas to discuss what the key barriers are to people who are homeless accessing end-of-life care and what the potential solutions are.

More than 50 people heard about the fantastic work of Peter Kennedy and the Palliative Care service at St Mungo’s. Over the last five years, the service has helped over 200 hostel staff receive training on end-of-life care and has provided one-to-one support to over 50 residents. This has enabled them to exercise more choice over their place of care and death.

However, it is clear that for many people who are homeless, there are no choices around place of care and death as so few of them receive any support at the end of their lives.

Several key themes emerged that could explain the lack of access to end-of-life services for people who are homeless including:

  • The inflexibility of current services to meet the needs of those with “chaotic” lives

  • The lack of information sharing and co-ordination of care among the multiple care settings that a homeless person may encounter such as hostels, acute hospitals, GPs

  • The lack of clarity over who should take responsibility for funding care for the homeless population, who are often transient and may not live in the same area as their registered GP and may have a frequently changing place of residence

  • Lack of training and understanding and sharing of good practice in the specific area of end-of-life care for people who are homeless.

Several recommendations came out of the day including:

  • That we need more research into the needs and wishes of people who are homeless at the end of their lives as well as more data collection on the outcomes for homeless patients and their disease trajectories at end of life

  • Education across the whole system with a shared education model

  • A national network to focus on end-of-life care for people who are homeless, feeding into existing networks on homeless health and end-of-life care, to ensure that this issue is included within wider work in both these areas

  • Develop a role for an advocate for homeless people at the end of their lives that can assist them in navigating health and social care. The role would need to be holistic and client-focused and have a recognised status as someone who can manage information on behalf of a patient

  • That we use an evidence base to commission new services, which are more appropriate to this client group, such as specialist hospices

  • That we challenge those working in end-of-life care such as Dying Matters and the National Council for Palliative Care to ensure that end-of-life care truly is for everyone, including people who are homeless.

The next steps are that a short report on the outcomes of the day will be circulated among participating stakeholders and published on the Marie Curie website.

We also plan to create a national network for end-of-life care for people who are homeless to endeavour to take the group’s recommendations forward.

On a personal note – I was delighted to see so many people give up their time to be at this week’s event. The enthusiasm and commitment of everyone in the room was evident from the very beginning. I feel incredibly hopeful that this could be the start of making a big difference for a group of people who very much need it.