Delivering high quality, personalised palliative and end of life care for people experiencing homelessness

LTP Priority: Stronger NHS action on health inequalities

Population Intervention Triangle: Segments (link to Section 1 PHE PBA): Service

Type of Interventions: Delivering high quality, personalised palliative and end of life care for people experiencing homelessness

Major driver of health inequalities in your area of work

High rates of morbidity with significantly lower life expectancy, some of worst health outcomes in society.  People affected by homelessness die, on average, around 30 years earlier than the general population. Outside London, where people are more likely to sleep rough for longer, support needs may be higher. 31% of people affected by homelessness have complex needs, and additional financial, interpersonal and emotional needs that make engagement with mainstream services difficult. 50% of people sleeping rough have mental health needs.

Target groups

People living in deprived areas, omeless and rough sleepers, protected groups – age, ethnic origins, sexual orientation, gender identity, disability or social circumstances, LGBT people and Gypsy and traveller groups.

Intervention

Delivering high quality, personalised palliative and end of life care for people experiencing homelessness

Description

Five key principles are necessary to delivery and embed personalised end of life care:

  • Good communication which includes engaging with people in a way that is meaningful for the individual and so enables people to make informed decisions about their care.  Advanced care planning is key to delivery of personalised care. A consistent process for recording wishes in a way that is led by the individual has been developed to be used by all agencies.
  • An approach founded on dignity and respect, investing in a relationship of trust, shifting the focus to make the point at which someone’s health is a cause for concern the trigger for action so that people are identified earlier.
  • The provision of workforce training and support. For example, a palliative care coordinator could deliver training to frontline staff dealing with end of life issues, strengthening links between hospices and hostels.
  • Enabling partnership working at a strategic level. Introduce multi-agency meetings to discuss clients of concern and provide person-centered care.
  • Recognizing that people are all different so inclusive, equitable care is not about treating everybody the same way. Wherever people with advanced ill health want to be, services and skilled staff should be in place to support them. Where someone with advanced ill health wants to remain in a hostel, in-reach into hostels and day centres from a range of professionals and services should be available.

Steps you can take to implement these principles:

  • St Mungo’s. Here the service, which was originally developed in partnership with Marie Curie, is led by the palliative care coordinator. The palliative care coordinator chairs a multidisciplinary working group to identify residents whose health may be deteriorating and may require additional support. Membership of this group includes the local alcohol service, GP, hostel and hospice staff,  This model also provides appropriate training and support hostel staff to enable them to have conversations with residents who may be approaching the end of life.
  • In Southampton a multi-agency approach to supporting advance care planning aims to ensure a proactive and consistent approach to supporting advance care planning for people who are homeless across the city. The project started in 2012, and continues to develop on an iterative basis and be embedded in local homelessness and substance misuse services. It is funded through Southampton City Clinical Commissioning Group and Southampton City Council.
  • St Luke’s (Cheshire) Hospice has developed a dedicated homelessness project. Whilst its initial focus was around training hostel staff to identify and support patients at the end of life, this has expanded to include the provision of dedicated counsellors at a Medical Practice for the Homeless and Salvation Army hostel for a number of hours each week, and working with local hepatology teams and consultants to raise awareness of hospices and referral routes

These steps are simple to implement across the system and will ensure that people who are homeless get the same choices as others when planning their end of life care and ensuring they have personalised care and support.

Evidence

  • Care committed to me – Delivering high quality, personalised palliative and end of life care for Gypsies and Travellers, LGBT people and people experiencing homelessness. A resource for commissioners, service providers and health, care and support staff.

Guidance for Commissioners

  • Care committed to me – Delivering high quality, personalised palliative and end of life care for Gypsies and Travellers, LGBT people and people experiencing homelessness. A resource for commissioners, service providers and health, care and support staff.