56 Simon Communities of Ireland Appendix 3. Continued 5. Care in last days of life When an individual enters the dying phase, it may appear to happen suddenly or as the culmination of a gradual process. It is vital that staff can recognise when someone is dying and take the appropriate action. ‘There are people who appear to be very unwell and then get through it,’ says Ms Smith. ‘For some people, it is a rollercoaster approach to the end of life. Preparedness can never come too early, but don’t run in saying, “This is the end”.’ Every client’s needs at the end will be different. ‘The key is knowing who is local - who is the local rabbi, who is the Greek Orthodox priest? At the eleventh hour, if people do want someone, you don’t want to be scrambling around,’ says Ms Smith. She also warns not to make assumptions. ‘Sometimes people think there has to be a “Cilla” moment - if someone is unwell they must be reunited with someone. It comes back to asking that individual what they need and who they want to see. There is an urge to want everything tied up in a neat bow, but life isn’t like that.’ Hostel managers should also consider the distress that watching a client die could cause staff and residents. ‘Obviously if you work with somebody over several years, it’s very hard to watch them die,’ says Mr Cockersell. Hostel workers also have an important role to play in managing the grieving process for other hostel residents. ‘There’s quite a lot of death around people in the homeless community - many will suffer from serial bereavement. If you aren’t addressing death, you can’t mourn properly,’ he says. 6. Care after death Death itself is not the end. Staff need to continue following good practice for the care and a viewing of the body, respect family wishes, and help friends and relatives of the deceased to cope with their loss. ‘End of life care is about people dying - that continues after death,’ says Ms Smith. ‘When someone has died, they are still a person and they must be treated with dignity and respect. Who needs to come and see that person? Has the individual stipulated that they want no one to see them? Are there customs that need to be carried out?’ Above all, the guide stresses that residents’ own choices are respected throughout, however hard that may be for hostel staff. As Mr Cockersell says: ‘These people won’t recover but, with good end of life care, they will recover some dignity and control over their lives.’
Homelessness, Ageing and Dying
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