Aldridge RW, Menezes D, Lewer D Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in england. Wellcome Open Research. 2019; 4:(1)1-17

Alker C Why community specialist practitioner district nurses should promote tissue donation. British Journal of Community Nursing. 2021; 26:(6)296-301

Batchelor P, Kingsland J Improving the Health of the Homeless and How to Achieve It within the New NHS Architecture. Int J Environ Res Public Health. 2020; 17:(11)

Rapid response to: there is no excuse for homelessness in Britain in 2018. 2018.

Canham SL, Davidson S, Custodio K, Mauboules C, Good C, Wister AV, Bosma H Health supports needed for homeless persons transitioning from hospitals. Health Social Care Community. 2017; 27:(1)531-545

New research is set to uncover the reasons poorer people are less likely to die at home. 2019. (accessed 20 April 2022)

Crisis. Homelessness monitor. 2022a. (accessed 18 March 2022)

Crisis. Health and wellbeing. 2022b. (accessed 18 March 2022)

Crisis. About homelessness. 2022c. (accessed 17 March 2022)

Davis-Berman J Serious illness and end-of-life care in the homeless: examining a service system and a call for action for social work. Social Work & Society. 2017; 14:(1)1-11

Driessen A, Borgstrom E, Cohn S Placing death and dying: Making place at the end of life. Soc Sci Med. 2021; 291

Fleshner MJ, Kennedy AJ, Veldkamp PJ, Childers JW Would you be surprised if this patient died this year? advance care planning in substance use disorders. J Gen Intern Med. 2019; 34:(11)2630-2633

Supporting people with substance problems at the end of life. 2019. (accessed 18 April 2022)

Guest H A concept analysis of trauma-informed care. Nurs Forum. 2021; 56:(4)1000-1007

Håkanson C, Sandberg J, Ekstedt M, Kenne Sarenmalm E, Christiansen M, Öhlén J Providing palliative care in a swedish support home for people who are homeless. Qual Health Res. 2016; 26:(9)1252-1262

Hassanally K, Asaria M Homeless mortality data from East London. London J Prim Care (Abingdon). 2018; 10:(4)99-102

Hauff AJ, Secor-Turner M Homeless health needs: shelter and health service provider perspective. J Community Health Nurs. 2014; 31:(2)103-17

Homeless Link. The unhealthy state of homelessness: health audit results 2014. 2014. (accessed 29 April 2022)

Homelessness Reduction Act. Homelessness reduction act 2017. 2017. (accessed 18 March 2022)

Hudson BF, Shulman C, Low J Challenges to discussing palliative care with people experiencing homelessness: a qualitative study. BMJ open. 2017; 7:(11)

Findings: dying homeless project. 2021. (accessed 12 April 2022)

Klop HT, van Dongen SI, Francke AL The Views of homeless people and health care professionals on palliative care and the desirability of setting up a consultation service: a focus group study. J Pain Symptom Manage. 2018; 56:(3)327-336

Marie Curie. Caring for people experiencing homelessness in palliative care. 2022. (accessed 12 April 2022)

Recommendations for improving the end-of-life care system for homeless populations: a qualitative study of the views of Canadian health and social services professionals. 2012.

Ministry of Housing. £3.2 million emergency support for rough sleepers during coronavirus outbreak. 2020. (accessed 12 April 2022)

NHS England. Ambitions for palliative and end of life care: a national framework for local action 2021-2026. 2021. (accessed 21 April 2022)

NHS England. Primary care networks. 2022. (accessed 21 April 2022)

NHS Long Term Plan. The NHS long term plan. 2019. (accessed 18 March 2022)

Nyatanga B Dignity in death: implementing the NHS Long Term Plan. Br J Community Nurs. 2019; 24:(3)

Office for National Statistics. National life tables – life expectancy in the UK: 2018 – 2020. 2021a. (accessed 22 March 2022)

Office for National Statistics. Deaths of homeless people in England and Wales: 2020. 2021b. (accessed 17 March 2022)

Pathway. Homeless and inclusion health standards for commissioners and service providers. 2018. (accessed 29 April 2022)

Pathway. Homelessness and general practice. 2019. (accessed 17 March 2022)

Pathway. Homeless palliative care toolkit. 2022. (accessed 17 April 2022)

Paudyal V, MacLure K, Buchanan C, Wilson L, Macleod J, Stewart D ‘When you are homeless, you are not thinking about your medication, but your food, shelter or heat for the night’: behavioural determinants of homeless patients' adherence to prescribed medicines. Public Health. 2017; 148:1-8

Pope ND, Buchino S, Ascienzo S “Just like jail”: trauma experiences of older homeless men. J Gerontol Soc Work. 2020; 63:(3)143-161

Public Health England. My right to healthcare. 2020. (accessed 20 April 2022)

Public Health Scotland. Adverse childhood experiences (aces). 2021. (accessed 13 April 2022)

Queen's Nursing Institute. District nursing today: the view of district nurse team leaders in the UK. 2019. (accessed 29 April 2022)

Queen's Nursing Institute. Facts about homelessness and health. 2020. (accessed 29 April 2022)

Queen's Nursing Institute. District nurses. 2021. (accessed 29 April 2022)

TEDx talks: how trauma informed care saved my life. 2020. (accessed 13 April 2022)

Shelter. 320,000 people in Britain are now homeless, as numbers keep rising. 2018.,000_people_in_britain_are_now_homeless,_as_numbers_keep_rising (accessed 29 April 2022)

End-of-life care for homeless people: a qualitative analysis exploring the challenges to access and provision of palliative care. 2018.

St Ann's Hospice. Homelessness and palliative care – the film. 2021. (accessed 17 March 2022)

Primary care provider experience and social support among homeless-experienced persons with tri-morbidity. 2015.

Homelessness kills: an analysis of the mortality of homeless people in early twenty-first century England. 2012. (accessed 19 April 2022)

Homeless individuals approaching the end of life: symptoms and attitudes. 2017.

Traynor R Are district nurses well placed to provide equitable end-of-life care to individuals who are homeless?. British Journal of Community Nursing. 2019; 24:(4)165-172

How 40 seconds of compassion could save a life. 2018. (accessed 20 April 2022)

World Health Organization. Global atlas of palliative care. 2020. (accessed 13 April 2022)

World Health Organization Europe. How can health care systems effectively deal with the major health care needs of homeless people?. 2022. (accessed 18 March 2022)

The challenges homeless people face when accessing end-of-life care: what district nurses need to know

02 October 2022
Volume 27 · Issue 10


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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