Researchers from Marie Curie Palliative Care Research Department at University College London (UCL), Pathway, St Mungo’s and Coordinate My Care, worked with homeless people and care professionals and found that many homeless people approaching the end of their lives are living in homeless hostels.
The study showed that hostel staff often end up caring for some of those needing the most care, despite not having the palliative care training or support to do so. As a result, huge burdens are placed on hostel staff who do their best to manage with minimal support and very limited resources.
The research is the largest of its kind, and the first to describe the lack of appropriate services for homeless people in the UK, from the perspectives of the homeless people themselves and those supporting them
Dr Caroline Shulman, Pathway and Marie Curie Palliative Care Research Department at UCL, who led the research, said:
“Hostels provide temporary accommodation. They are not designed to meet the needs of seriously or terminally ill residents. Hostel staff often struggle to secure additional support from social services or palliative care services for their residents who have complex problems.”
Many homeless people die young from conditions such as advanced liver disease, often complicated by mental health problems and/or drug and alcohol issues. There are differences in the type and amount of support available for this group across London.
However the researchers found that overall, homeless people with advanced ill health rarely receive adequate care and support in the community. This results in repeated unplanned and emergency hospital admissions in the last months, weeks or days of life, which can be very distressing.
One of the survey’s respondents, who has had experience of homelessness, commented:
“There have been a few guys that were in hospital, told they were dying …. They did not want to go to any hospice, they did not want to … stay in hospital, they wanted to die in the homeless hostel.”
The research calls for urgent action to improve collaboration between health, housing, social services and the voluntary sector, with extra support for hostel staff. It also makes recommendations for a specialist health hostel, with staff that not only understand the complex needs of homeless people but can also offer adequate 24-hour support for people with serious illnesses, including those who are dying.
Professor Steve Field, Chief Inspector of General Practice at the Care Quality Commission, said:
“As a GP I have seen how the lack of appropriate and sensitive services can mean that homeless people are denied the compassionate healthcare, dignity and respect that they deserve at the end of their lives. “
“This research makes it clear that by working together, healthcare services and the wider system – such as housing, social services and the charity sector – have a vital role to play in improving the quality and co-ordination of care for homeless people as they reach the end of life. Everyone has the right to safe, high-quality, and compassionate health and social care. Through our inspections we have seen services that are providing outstanding care to people who do not have secure housing but it takes strong, responsive leadership and dedicated staff.
“In the coming months CQC will be publishing a detailed report making recommendations on how we as a society can meet our responsibility to the most vulnerable people in our communities who are currently being let down at a time when they need help and support the most.”
Commenting in response, Carole Walford, Chief Clinical Officer of national hospice care charity Hospice UK, said:
“The fact that someone is homeless should not disadvantage and limit their access to the right care; care that will meet their end of life care needs.”
“Hospice UK is committed to tackling all inequality and making sure that everyone gets equal access to the best possible care at the end of their lives.”
“Our Open Up Hospice Care campaign, which launched this week, is aimed at widening access to hospice care, ensuring that this is available to all. It is important that homeless people have the same access to appropriate hospice services as everyone else.”