Aveyard H. Doing a literature review in health and social care: a practical guide.Maidenhead: McGraw-Hill/Open University Press; 2014

Baggett TP, O'Connell JJ, Singer D, Rigotti NA. The unmet health care needs of homeless adults: a national study. Am J Public Health. 2010; 100:(7)1326-1333

Critical Appraisal Skills Programme. CASP checklists. 2018. (accessed 12 February 2019)

Cole E. Ensuring dignity in death. Nurs Stand. 2017; 32:(1)18-20

Supporting homeless people with advanced liver disease approaching end of life. 2011. (accessed 20 February 2019)

Serious illness and end of life care in the homeless: examining a service system and a call to action for social work. 2017. (accessed 20 February 2019)

Department of Health and Social Care. End of life care: achieving quality in hostels and for homeless people—a route to success. 2014. (accessed 20 February 2019)

Department of Health and Social Care. Ambitions for palliative and end of life care: a national framework for local action 2015–2020. 2015. (accessed 5 February 2019)

Grenier P. Still dying for a home.London: Crisis; 1996

Hakanson C, Sandberg J, Ekstedt M, Sarenmalm E, Christiansen M, Ohlen J. Providing palliative care in a Swedish support home for people who are homeless. Qual Health Res. 2015; 26:(9)1252-1262

Homeless Link. The unhealthy state of homelessness health audit results 2014. 2014. (accessed 5 March 2018)

Homeless Link. Rough sleeping statistics—an analysis of 2018 rough sleeping counts and estimates. 2018. (accessed 12 March 2019)

Hudson BF, Flemming K, Shulman C, Candy P. Challenges to access and provision of palliative care for people who are homeless: a systematic review of qualitative research. BMC Palliat Care. 2016; 15

Tackling health inequalities: turning policy into practice?. 2004. (accessed 5 February 2019)

A review of single homelessness in the UK 2000-2010. 2010. (accessed 1 March 2019)

Keyes S, Kennedy M. Sick to death of homelessness: an investigation into the links between homelessness, health and mortality.London: Crisis; 1992

Krakowsky Y, Gofine M, Brown P, Danziger O, Knowles H. Increasing access-a qualitative study of homelessness in a major urban center. Am J Hosp Palliat Med. 2012; 30:(3)268-270

Leadership Alliance for the Care of Dying People. One chance to get it right: improving people's experience of care in the last few days and hours of life. 2014. (accessed 20 February 2019)

MacWilliams J, Bramwell M, Brown S, O'Connor M. Reaching out to Ray: delivering palliative care services to a homeless person in Melbourne, Australia. Int J Palliat Nurs. 2014; 20:(2)83-88

McNeil R, Giurguis-Younger M. Illicit drug use as a challenge to the delivery of end of life care services to homeless persons who use illicit drugs: perceptions of health and social care professionals. Palliat Med. 2012; 26:(5)350-359

Ministry of Housing, Communities and Local Government. Rough sleeping statistics—autumn 2018, England (revised). 2019. (accessed on 12 March 2019)

Nursing and Midwifery Council. Standards for medicines management. 2010. (accessed 13 March 2019)

Polit DF, Beck CT. Nursing research: generating and assessing evidence for nursing practice, 10th edn. Philadelphia (PA): Lippincott, Williams & Wilkins; 2016

Public Health England. Public health outcomes framework. 2012. (accessed 20 March 2019)

Public Health England. Homelessness: applying all our health. 2016. (accessed 20 February 2019)

The hidden truth about homelessness: experiences of single homelessness in England. 2011. (accessed 20 February 2019)

Shelter. Annual review. 2018. (accessed 1 March 2019)

Shulman C, Hudson B, Low J End of life care for homeless people: a qualitative analysis exploring the challenges to access and provision of palliative care. Palliat Med. 2018; 32:(1)36-45

Stringfellow EJ, Kim TW, Pollio DE, Kertesz SG. Primary care provider experience and social support among homeless-experienced persons with tri-morbidity. Addict Sci Clin Pract. 2015; 10

Homelessness kills: an analysis of the mortality of homeless people in early 21st century England. 2012. (accessed 20 February 2019)

Tobey M, Manasson J, Decarlo K, Ciraldo-Marynuik K, Geeta J, Wilson E. Homeless individuals approaching the end of life: symptoms and attitudes. J Pain Symptom Manage. 2017; 53:(4)738-744

Webb WA. When dying at home is not an option: exploration of hostel staff views on palliative care for homeless people. Int J Palliat Nurs. 2015; 21:(5)236-244

Webb WA, Mitchell T, Nyatanga B, Snelling P. Nursing management of people experiencing homelessness at the end of life. Nurs Stand. 2018; 32:(27)53-62

Are district nurses well placed to provide equitable end-of-life care to individuals who are homeless?

02 April 2019
Volume 24 · Issue 4


This literature review aimed to answer the focus question: are district nurses well placed to provide equitable end of life care (EOL) for homeless individuals? It focused on 10 primary research studies, from which two themes emerged and subsequently formed the basis of the discussion: (1) the difficulty in predicting disease trajectory in people who are homeless and (2) the gaps in existing systems. The main findings from these themes were a lack of education on the recognition of the dying and a general lack of knowledge of the complex challenges faced by and health needs of homeless people, which cause stigma from both the general public and health professionals towards these marginalised individuals. Further, there is certainly a lack of suitable places to deliver palliative and EOL care for people who are homeless. Available services are inflexible and have no tolerance for substance misuse, which creates an access barrier for homeless people in need of EOL care.

The homeless population in the UK is growing, and yet homelessness is a vastly under-reported problem (Reeve, 2011). According to recent estimates from the Ministry of Housing, Communities and Local Government (2019), around 4677 individuals sleep rough in England on any given night. However, these figures only include ‘rough sleepers’ (people who are sleeping on the streets) and do not include those who are staying with friends or ‘sofa surfing’. An analysis by Homeless Link (2018) shows that although there has been a 2% decrease in figures between 2017 and 2018, there has been an overall increase by 165% in the number of rough sleepers since 2010. In its annual review, combining government and local authority figures on rough sleeping, temporary accommodation and social services, Shelter (2018) estimated that the actual number of homeless individuals in Britain today is around 320 000.

Register now to continue reading

Thank you for visiting Community Nursing and reading some of our peer-reviewed resources for district and community nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • New content and clinical newsletter updates each month