End of Life and Palliative Care
What is this intervention?
End of life care aims to help individuals who are considered to be in the last year of life to live as comfortably as possible and to die with dignity. Palliative care is the ongoing care of people with advanced progressive illness. In both cases care includes the management of pain and physical symptoms, as well as emotional support. A key part of end of life care is choice; this means supporting people to be able to choose where they receive care in their last months of life. End of life and palliative care for people who are homeless requires a specialist and flexible approach because of the nature of their circumstances and complex needs.
There are a number of key challenges to the implementation of end of life care for the homeless population. Firstly, advance care planning is rare with this population so professionals may have to respond to an individual’s needs quickly without the opportunity to hear their wishes for end of life care. Secondly, a person who is homeless may not want to be confined to a hospital or hospice, and will inevitably not have a home, and instead may choose to stay in communal accommodation such as a shelter or hostel. This can cause practical difficulties for the end of life care team, accommodation staff, and other residents. Thirdly, estrangement from family and friends is common in the homeless population, which means difficult end of life decisions become the responsibility of the professionals. In some cases a homeless person may choose their case worker as their next of kin. The duration of end of life care is also unpredictable and continues as long as needed, which creates an added layer of complexity.
What is its goal?
End of life care for people experiencing homelessness aims to help people facing death to live as well as possible and die with dignity. It aims to give the individual as much choice as possible about where they spend this time and who they have around them. Palliative care aims to provide people who are homeless with ongoing support with advanced illnesses. Implementation needs to be flexible to respond to the more complicated circumstances and needs of the homeless population.