Supporting People Experiencing Homelessness with Life-Limiting Illnesses: A Research Perspective
This research discusses the support provided by staff in homeless accommodations for individuals facing homelessness and life-limiting illnesses. It covers the definitions and reasons for homelessness, the high risk of death in people experiencing homelessness, and common causes of mortality among this population. The aim is to shed light on the unique challenges faced by individuals in these circumstances and how palliative care needs can be addressed effectively.
- Homelessness support
- Life-limiting illnesses
- Palliative care
- Homeless accommodation
- Healthcare services
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author. Download presentation by click this link. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
E N D
Presentation Transcript
How staff in homeless accommodation support How staff in homeless accommodation support people experiencing homelessness with life people experiencing homelessness with life- - limiting illness(es) limiting illness(es) Dr. Aoibheann Conneely Research Fellow Academic Dept of Palliative Medicine, Our Lady s Hospice and Care Services, Dublin Special Lecturer in Palliative Medicine, University College Dublin aconneely@olh.ie
Outline of my talk 40 minutes: aim 30 minutes + allow 10 minutes for discussion the end Introduction + Background Our research How this is applicable to you Next steps in our work Discussion + Questions
Case example Tom
Definitions of homelessness The Housing Act 1988 Homeless and at risk of homelessness Definitions vary1,2and encompass Roofless Houseless Insecure housing Inadequate housing Current homeless figures: 10,275 homeless people in Ireland July 20193 Note: this does not include those in LTA within homeless services 1FEANTSA 2006. ETHOS taking stock 2 Chamberlain 1992 3Department of Housing, Planning & Local Government Homelessness Report July 2019
Reasons for homelessness Structural Structural Individual Individual Adverse childhood events Complicated by tri-morbidity Drugs and alcohol Both a cause and an effect of homelessness
Death in people experiencing homelessness People experiencing homelessness have a Higher risk of death than the housed population1 Worse health status1 Demonstrate premature aging2 Standardised mortality rates for homeless people in Dublin3 3-10 times higher in men 6-10 times higher in women 1Aldridge 2018 2 Brown 2017, N Cheallaigh 2018 3 3 Ivers Ivers2019 2019
Cause of death Not a perfect marker of palliative care needs1 However, it is a starting point Reported causes of mortality in Dublin for people experiencing homelessness are2 Drugs and/or alcohol (38.4%) Circulatory causes (20%) Respiratory causes ( 13%) Gastrointestinal causes ( 7%) Cancer ( 5.1%) 1 Murtagh 2014, Rosenwax 2005, Francks 2000, Kane 2015 2 Ivers 2019
Place of death Place of death is considered by some to be a KPI in palliative care 1 More nuanced issue in reality 2 In Ireland: place of death for people experiencing homelessness3 Hospital ( 49.7%) Homeless services (29.7%) Outdoors (10%) Hospice (4.4%) Private resident (4.9%) Prison (0.4%) 1 Gomes 2012 2 Hoare 2015 3 Ivers 2019
Research on this topic 3 large systematic reviews recently published: Klop Klop et al. Palliative Care for homeless people: a systematic review of the concerns, care needs and preferences, and the barriers and facilitators for providing palliative care. BMC Palliative care. 2018 Hudson Hudson et al. Challenges to access and provision of palliative care for people who are homeless: a systematic review of qualitative research. BMC Palliative Care. 2016 Sumalinog Sumalinog et al. Advance care planning, palliative care and end-of-life care interventions for homeless people: A systematic review. Palliative Medicine. 2016 Biggest single study on this topic: UCL group UCL group Shulman Shulman et al. End of life care for homeless people: A qualitative analysis exploring the challenges to access and provision of palliative care. Palliative Medicine. 2017 Developed a toolkit: https://www.homelesspalliativecare.com/about/
Our research Qualitative Study exploring the experience of Homelessness Staff working with Qualitative Study exploring the experience of Homelessness Staff working with homeless people with life homeless people with life- -limiting illnesses in Dublin, Ireland. limiting illnesses in Dublin, Ireland. A Conneely1, R McQuillan2,3, S Marshall4, K Bristowe4 1 ADPM, OLH&CS, Harold s Cross, Dublin 2 St Francis Hospice, Dublin 3 Beaumont Hospital, Dublin 4 Cicely Saunders Institute of Palliative care, Policy & Rehabilitation, King s College London Poster abstract: Palliative Medicine 2018; 3-330 Full Paper: submitted for publication.
Note on our terminology Participants People experiencing homelessness Service-users
Aims 1.) Explore the experience of staff in homeless accommodation services working with people experiencing homelessness with life-limiting illness(es). 2.) Identify areas for collaboration between palliative care and other health and social care services.
Results 11 participants were recruited from 4 organisations.
Key Themes poor communication between hospitals and homeless accommodation services concerns about medication handling uncertainty about prognosis, particularly in non-malignant conditions, and concerns that they could not meet the care needs of an individual at the end-of- life. Participants felt that health and community services staff do not have knowledge of the structure and staffing levels in homeless services and assumed for example, there was nursing support. Participants identified a strong wish to support a service user at the end of their life but had substantial concerns that they were not adequately trained to do so. Participants would welcome education opportunities on the topic of end-of-life care and advanced care planning.
Discussion The provision of palliative care to homeless people is complex. Understanding the needs of homeless people who have physical health, mental health and substance misuse problems is vital in providing person-centered care. Collaborative work including sharing of skills and education opportunities between health, palliative, homeless and social services is required to improve care for homeless people with life-limiting illnesses.
Areas for collaborative education, research and advocacy
Acknowledgements Dr. Regina McQuillan, Beaumont Hospital and St Francis Hospices Professor Cl ona N Cheallaigh, Inclusion Medicine, St James s Hospital Staff in the Dublin Homeless Regional Executive Staff in homeless accommodation services in Dublin who coordinated my interviews Participants in the study Dr. Katherine Bristowe, Cicely Saunders Institute, King s College London Dr. Steve Marshall, Cicely Saunders Institute, King s College London Dr Jo-Hanna Ivers, Trinity College Dublin Dr. Austin O Carroll, Safetynet MSc in Palliative Care, King s College London
Contact details Email: aconneely@olh.ie
