Homelessness, Ageing and Dying 23 Liver failure is frequently a contributing factor, which brings a number of complications, including memory loss and, as it is often caused by problematic drinking and drug use, people are often less willing to engage with health professionals in the first place. It is also the case that staff who work with people who are homeless who have moved into hostel accommodation may not encounter it often, making it much harder to predict or prepare for. Marie Curie Cancer Care, in partnership with the Homeless Charity St Mungo’s, recently produced a report71 on supporting people who are homeless with advanced liver disease approach end of life. The purpose of this study was to help identify the issues and signals used to detect when end of life is approaching, and facilitate staff to offer the best possible palliative care and advice for friends, family and other staff. Getting end of life care right is clearly important not only for those who die, but for other residents, staff and the wider homeless community72. Another interesting element of the services provided at St Mungos has been the appointment of the first ever Palliative Care Co-ordinator whose role was to help in the identification of individuals nearing end of life73 and to raise staff awareness of the signs of end of life and thereafter to train and support staff to identify and provide best possible care and support for individuals at the end of their lives and in their care. In this context the publication (drawing on the experiences of St Mungo’s) by the NHS of a guide74 entitled ‘End of Life Care: Achieving quality in hostels and for people who are homeless- a route to success’ is a welcome development (See Appendix 3 for details). 2.15 Other Supports for people who are homeless with serious ill health 2.15.1 Nationally The Primary Care Safety Net Initiative launched in 2007 aims to provide a dedicated, cohesive and comprehensive primary health care service for people who are homeless in Dublin, Dundalk, Galway and Cork75. The Primary Care Safety Initiative is a coordinating partnership which includes the Health Service Executive, General Practitioners and the Voluntary Sector. It provides specialised health care services targeting the homeless population in settings that they use on a regular basis such as hostels and community based support services (SafetyNet, 2009:5). In addition, SafetyNet supports medical practitioners, who might otherwise experience isolation, and promotes best practice clinical standards among SafetyNet members. One of the additional services the providers of the SafetyNet Initiative would like to see developed is the provision of “an intermediate care facility designed for people who are homeless who have been discharged from hospital but who are too sick to return to their homeless accommodation or to the streets”. This facility would be similar to that proposed by O’Carroll76 and would be particularly relevant to people who are homeless and who have been diagnosed in primary care with health conditions of such severity that homeless accommodation is unsuitable but hospitalisation is unnecessary 77. 71 Marie Curie Palliative Care Research (2011) Supporting homeless people with advanced liver disease approaching the end of life. University of London & St Mungos 72 Puckett, Katie, Dignity in Death article in e-magazine Inside Housing printed on 28th January 2011 http://www.insidehousing.co.uk/analysis/best-practice/dignity-in-death/6513430.article 73 Interview with Peter Kennedy , Palliative Care Coordinator St. Mungos 27 January 2012 74 NHS (2010) ‘End of Life Care: Achieving quality in hostels and for homeless people -a route to success. This guide identifies six key steps for end of life care for people who are homeless 75 Downey, Daithi (ed.) (2008) Perspectives on Irish Homelessness: Past, Present and Future. The Homeless Agency, Dublin. 76 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 77 Downey, Daithi (ed.) (2008) Perspectives on Irish Homelessness: Past, Present and Future. The Homeless Agency, Dublin 8.
Homelessness, Ageing and Dying
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