Homelessness, Ageing and Dying 25 Dedicated supports for people who are homeless in an Irish context include the Primary Care SafetyNet Initiative which operates in Dublin, Dundalk, Galway and Cork. The majority of older people (over 65 years) die in acute and/or long-stay care settings in Ireland. Good practices for end of life care include consideration of the person’s wishes at all stages of the care process (including any advance directives made prior to the onset of incapacity). There may also be a role for an independent advocate in assisting the person to make decisions about their care. The absence of a formal national system for recording the number, cause, 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. International studies exploring the experiences and attitudes of people who are homeless toward death found individuals fearful and concerned about death, dying and end of life care. The UK experience suggests that few people who are homeless present for hospice care because of a high level of non- engagement with services and the prevalence of problematic behaviour. Delivering high quality end of life care for people living in hostels or on the streets presents particular challenges for housing and healthcare. Liver failure (often caused by problematic drinking and drug use) is frequently a contributing factor to early mortality. Some interesting initiatives developed in the UK to address the end of life needs of people who are homeless includes a) the appointment of Palliative Care Co-ordinator whose role it is to help in the identification of individuals nearing end of life and to train and support staff to identify and provide best possible care and support for such individuals; b) the publication by the NHS of an End of Life Care: guide for people who are homeless-and living in hostels and c) the London Pathway Integrated Healthcare initiative designed to support hospitalised rough sleepers and single people who are homeless and attending hospital.
Homelessness, Ageing and Dying
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