44 Simon Communities of Ireland SECTION 4 Conclusions and Recommendations 4.1 An Overview The purpose of this research was to identify and examine the needs of older people who are homeless or who have previously experienced homelessness as they age and are faced with the issues of serious ill health, dying and death. Among the key needs identified as a result of this research include the need for: • Access to appropriate health care. • Services which contribute to good health and well-being. • End of life care. • Suitable and stable accommodation and accommodation support. • Information and research. The provision of these services alone is not enough. The services need to be capable of addressing the complex (interconnecting physical and mental health and social) needs of older people who are homeless and dealing with poor health and issues related to dying and death. The remainder of this section examines these under five thematic headings. 4.2 Appropriate health care Research has shown that individuals who have a long term history of homelessness have higher levels of physical and mental illness, problematic drug and/or alcohol use and higher death rates than the general population.The average age of death for a person who is homeless is 47 for men and 43 for women. This research found the majority of interviewees were living with serious physical and mental health conditions, including, chest and heart problems as well as advanced liver disease. Across the country there are some specialists services available to people who are homeless particularly in urban centres (e.g. the Primary Care Safety Net Initiative which currently operates in Dublin, Galway and Cork) however there are none dealing specifically with older people who are homeless. The interviewees involved in the research perhaps because they were connected to Simon services (and also known to wider services) all had a medical card and a GP (they generally liked) and some had regular contact with the health nurse in relation to on-going management of certain chronic conditions. Individuals living in hostels also had the benefit of hostel staff monitoring their health. Mobility issues (where people need to be accompanied to appointments) and access to transport (particularly for those living in rural areas) were obstacles for individuals in terms of their ability to access primary health services in particular. Attending hospital appointments and/or A&E was however an issue for many interviewees who were fearful a) of being admitted to hospital, b) of not being able to get alcohol, c) of getting bad news, and/or d) being unable to return to their current accommodation and having to move to a nursing home. These fears were indeed clearly providing a significant barrier to individuals accessing the services they
Homelessness, Ageing and Dying
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