The challenges homeless people face when accessing end-of-life care: what district nurses need to know
People experiencing homelessness have poorer physical and mental health compared with the rest of the population. Mortality rates are significantly higher, yet there is a dearth in suitable places for the delivery of palliative and end-of-life (EOL) care. Homeless people are being failed by the current healthcare system. The stigma associated with being homeless negatively impacts these marginalised people, affecting care given from healthcare professionals (HCP). Services are often inflexible and have little tolerance for substance misuse.
District Nurses (DN) are often experienced EOL care practitioners and well-placed to give person-centred care with a focus on collaborative decision-making. However, many homeless people die without input from DNs or specialist palliative support. It is important to understand why this is happening to address what can be done to help.
Everyone has the right to palliative care when needed (World Health Organization (WHO), 2020); yet, untrained staff working in hostels, homelessness charities and supported housing end up providing support to those approaching end of life (EOL) (Pathway, 2022). The focus on recovery can often mean that young people dying of potentially preventable disease are denied access to palliative care support (St Ann's Hospice (SAH), 2021). More needs to be understood for this ‘invisible’ group in society. Homeless people often experience a range of difficulties accessing the current healthcare system, such as access to a GP, medical appointments or medications for chronic conditions (Pathway, 2019).
It is acknowledged that homeless people receive poorer quality EOL care (NHS England, 2021). The Ambitions for palliative and end of life care: a national framework for local action policy attempts to ensure equitable palliative care exists regardless of socioeconomic status (NHS England, 2021). However, this is not the first policy to highlight inequity, and homeless deaths continue to occur in acute or unsuitable settings without advance care planning (Hudson et al, 2017; Tobey et al, 2017; Traynor, 2019).
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