Homelessness, Ageing and Dying 21 social isolation and economic hardship and are less likely to access palliative care than their younger counterparts’ (p 101). Harris60 (1990) indeed describes this group as the ‘disadvantaged dying’. The Irish Hospice Foundation has developed or funded a range of training programmes to help facilitate and connect key care and medical staff with end of life care and their local hospice. These programmes include a ‘Link Nurse Initiative’, a pilot programme in which local hospice education centres train nurses working in nursing homes/community hospitals in order to enhance their own skill and to help them to connect and make linkages between their patients and the local hospice/s. A second initiative is a staff development programme called ‘Final Journeys’, which helps examine attitudes and understanding of end of life, originally in the hospital setting, but which could be adapted for use with a variety of care staff (including staff in homeless agencies). The Foundation also provides a range of bereavement and loss education inputs and this includes linking problematic drug/alcohol use and loss issues. 2.13 Experiences/attitudes towards dying and death among older people who are homeless There are no specific health services targeting older people who are homeless. So it is not surprising to find that there is little ‘if any’ information available or indeed work done on the experiences and attitudes towards dying and death among older people who are homeless in an Irish context. Neither is there any information available on the mortality rates and causes among people who are homeless, making it difficult to quantify and qualify both the extent or the problem and the nature of the issues involved. Some work has been from the perspective of homeless sector workers and how they deal with death. The study, which was undertaken in 200961, involved homeless sector workers from around Dublin. The study explored how these workers dealt with death and described the processes that enabled them to deal with the experience in a way that enabled them to maintain a positive view of their work and service users. A series of very useful resources62 designed to support homeless sector workers were developed as a result of this work and these provide a useful source of training and support materials for homeless sector workers. Interestingly, some work has also been done in an Irish context on Traveller’s and gypsies’ attitudes to dying and death.63 64 There are very few international studies that have explored the experiences and attitudes of people who are homeless toward dying and death. One of the few studies on the subject ‘undertaken in the US’ found that many participants were of the view that deaths—particularly early ones—may have contributed to their present homelessness. (i.e. the death of a parent/care giver early in the participants lives). The study also found that many of the study participants had lost a loved one or caregiver early in life (this was especially the case for older people who were homeless). Others had lost loved ones or friends who were also living on the streets. Study participants were generally found to be quite fearful and concerned about death, dying and end of life care, given that death on the streets can be more traumatic and demeaning than deaths that domiciled people may experience. They were able to site numerous brutal experiences with/of dying and death. They had developed a variety of coping strategies to deal with these fears, including a sense of fatalism or isolation and emotional detachment and/or the use of humour. Some had even employed risk management techniques as a means of dealing with death including advance care planning and documentation which ‘for some’ involved discussion with significant others and/or appointment of a proxy while for others it meant some form of documentation of wishes or contact information. 60 Harris, L (1990) Continuing Care: The disadvantaged dying. Nursing Times, 86(22): 26-9 61 Lakeman R. (2010) How Homeless Sector Workers Deal with the Death of Service Users: A Grounded Theory Study. Journal of Death Studies. 62 These can be assessed at http://www.working4recovery.com/death/ 63 McQuillan, R & Van Doorsaler, O. (2007) Indigenous ethnic minorities and palliative care: Exploring the views of Irish Travellers and palliative care staff. Pallitive Medicine, 21 (7): 365-41 64 McQuillan, R (2011) Traveller’s and gypsies’ dying and death pp 159-165. In Death Dying and Social Differences (ed Oliviere, D, Monroe, B and Payne, S) Oxford University Press
Homelessness, Ageing and Dying
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