22 Simon Communities of Ireland The study found that death related experiences associated with health care providers were generally negative. The majority believed professionals were not concerned for their health because they were homeless and were deemed less worthy of treatment than citizens from the general population. The author suggests that these negative experiences with health care providers and institutions should be researched further as a possible contributor to continued homelessness. The attitudes toward death among people who are homeless may also shed light on high risk behaviours and risk management strategies employed. It is not clear whether the learning arising from studies done with other vulnerable population groups is relevant to people who are homeless, given that people who are homeless/have experience of homelessness may have a number of very distinct and unique characteristics65 including the following: • A lack of access to stable and safe accommodation which underlines the fragility of life. • Limited access to the services which contribute to good health and wellbeing & high levels of poor health. • Exclusion from institutions providing health care often due to poor treatment by heath care providers. • Complex needs (that include multiple and interconnecting physical and mental health and social needs). 2.14 End of life care for people who are homeless The absence of a formal national system for recording the number, cause and nature of death and tenancy type of people who are homeless in Ireland means that significant gaps exist in our understanding of the experience of dying and death for people who are homeless. This is compounded by that fact that we do not know how many, ‘if any’, people who are homeless present for hospice care. The UK experience suggests that few if any people who are homeless tend to present for hospice care because of a high level of non-engagement with services and the prevalence of perceived problematic behaviour.66 A working group has recently been formed in the UK to bring together homeless support organisations to begin the process of recording deaths. Delivering high quality end of life care for people living in hostels or on the streets presents particular challenges for housing and healthcare for a number of ‘reasons’ including the fact that the average age of death is lower (47 for men and 43 for women according to the most recent study).67 68 It is also the case the admissions among this group tend to be crises admissions which require longer stays and which sometimes result in the individuals being discharged and sent back to the hostel. This in turn can be problematic because the individuals may as a result of their illness have additional care needs. The intermediary care model69 (proposed in an Irish context by Dr. Austin O’Carroll and others) offers a potential solution to this problem if some of the beds provided in this type of facility could be provided for individuals with palliative care needs. It is also the case that a small number of palliative care (level II) beds may be available in community hospitals around the country.70 The exact number of beds available is ‘unclear’ as is the capacity of these hospitals to deal with individuals who may present with both complex needs and challenging behaviour. The willingness of individuals who are homeless to present to these hospitals is also something of an unknown. 65 Song, John, et al. (2007) Experiences with and Attitudes Toward Dying and death among Homeless persons J Gen Intern Med. 2007 April; 22(4): 427–434. Published online 2007 January 18. 66 Interview with Peter Kennedy , Palliative Care Coordinator St. Mungos 27 January 2012 67 Crisis (2011) Homelessness: A silent killer: A research briefing on mortality amongst homeless people 68 This is significantly less than the life expectancies identified for the Traveller population (another often sited vulnerable group). The average life expectance of a male Traveller was found to be on average 10 years less than settled men and 12 years less for a Traveller women according to the National Intercultural Health Strategy 2007 – 2012. 69 O’Carroll, A. O’Reilly, F. Corbett, M & Quinn, L (2006) Homelessness, Health and the case for an Intermediate Care Centre Report by Mountjoy Street Family Practice 70 Communication (29/3/2012) Caroline Lynch, Communications/Advocacy Manager, The Irish Hospice Foundation
Homelessness, Ageing and Dying
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