Homelessness, Ageing and Dying 47 6. Raise awareness of the spiritual needs of older people who are homeless among staff Staff working with people who are homeless need to be made more aware of the spiritual needs of people who are homeless and of the supports that could be put in place to meet these needs. (The IHF workshops on spiritual care at the end of life could provide a useful source of material for this area). The implementation of these recommendations would meet some of the national and policy objectives identified in the: • Various regional Homeless Action Plans many of which recognised the need for social facilities for people who are homeless. • “Vision for Change” Report of the Expert Group on Mental Health Policy – which highlights the importance of belonging and participating for people with mental health issues. • The National Health Strategy – which identifies a number of initiatives to improve the well- being of people who are homeless. • The Way Home: The National Homeless Strategy 2008-2013 Strategic Aim 5 – ensure effective services for homeless people links the provision of health services to the roll-out of primary and social care networks. 4.4 End of life care The majority of older people (over 65 years) in Ireland die in acute and/or long-stay care settings. There is no definitive information on where older people who are homeless (over 50 years) die, neither do we know how many, if any, people who are homeless present for hospice care. Interviewee’s views and experiences (coupled with experience from the UK and international research) suggest that the majority probably die in acute hospital settings, given their levels of ill health and non-engagement with services, the prevalence of problematic behaviour and their aversion to nursing homes. Among the most common causes of death among people who are homeless are multiple organ and liver failure, which bring with them a number of complications including memory loss with problematic drinking, frequently a contributing factor to early mortality. Delivering high quality end of life care for people who are homeless clearly presents particular challenges for housing and healthcare. International studies exploring the experiences and attitudes of people who are homeless toward death found a lot of fear and concern about death, dying and end of life care. Most interviewees in this research had, often because of poor health or difficult experiences (particularly when sleeping rough), thought about death and their death in particular. Some interviewees had had various suicide attempts. Most were fearful about death, the thought of dying kept some awake at night while others tried to keep the thoughts at bay with alcohol and/or prayer. Most either did not want to die or were afraid of dying. A small number said they were happy to die and ‘were the opportunity to present itself’ they would consider suicide. Very few had thought about what they might want at the end of their lives and only one individual had made any preparations for his death. For those individuals that had thought about what they might want, they generally wanted to have family close or to make peace with their family and their children before they died. Many more had thought about what they did not want, the vast majority did not want to die alone, and if they did, they wanted to die in their sleep and be found quickly. This was a particular issue for those individuals estranged from their family. Transfer to a nursing home was what many feared most. The majority had not spoken about death or dying to anyone. Where individuals had tried to raise the issue of their death with people working with them, most people were found to be reluctant to engage in this type of conversation and quick to change the subject.
Homelessness, Ageing and Dying
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