Social justice in end-of-life care

Compared with the general population, people experiencing homelessness are twice as likely to have a long-term health condition; yet, they are frequently excluded and overlooked when it comes to healthcare provision (Care Quality Commission (CQC), 2020). People experiencing homelessness also tend to die young, often in their 40s, without access to palliative care support (CQC, 2017). I still find this statistic shocking every time I read it, and it prompted my masters (Webb, 2015) and PhD research (Webb et al, 2020) in this niche subject.

The findings of my doctoral research revealed that homeless people fear needing care more than they fear death itself and so would rather ‘drop dead suddenly’ than receive a palliative diagnosis and need personal care (Webb et al, 2020). However, without a palliative diagnosis, it is difficult for people experiencing homelessness to access traditional palliative care services and support. They tend to fall through the cracks in the system, which means that they often die in hostels or in emergency departments. Worse still, some die in shop doorways and on park benches, alone and with very little dignity. Further, finding it difficult to trust people, those experiencing homelessness need to feel comfortable with caregivers or helpers at the end of life (Webb et al, 2020). They want to be somewhere that they can truly be themselves, where they do not feel judged or misunderstood. Simply put, when approaching the end of life, people experiencing homelessness are more likely to want to be cared for in the familiar hostel setting (Webb et al, 2020).