Personalised end of life care for the homeless

‘Care committed to me’ is a new resource that aims to help improve personalised end of life care for people experiencing homelessness, LGBT people and Gypsies and Travellers.

 In this blog post we look at how the guide could help you in your work to support people who are homeless.

Set within the context of relevant research and describing simple effective approaches for success, ‘Care committed to me’ is intended for commissioners, service providers and those involved in caring for and supporting children, young people and adults living with advanced illness towards the end of their lives.

It features case studies with top tips from the contributors, quick-read highlights on providing and commissioning personalised end of life care and further reading. The new resource also aims to put into practice the six commitments made by the Government to end variation in end of life care across the health system by 2020.

The resource is a multi-organisational project led by Hospice UK, Marie Curie and Together for Short Lives. They worked with partner organisations Homeless Link, the National LGB&T Partnership, and Friends, Families and Travellers. The project was funded by the Health and Wellbeing Alliance, a partnership arrangement between NHS England, the Department of Health and Social Care, and Public Health England.

The importance of partnership working

In exploring what works to improve care for people experiencing homelessness, the guide was based on a literature review and call for evidence, and informed by a practical workshop. This event brought together palliative care professionals with colleagues from the homelessness and wider health sector to discuss established and emerging practice and identify further opportunities to work together.

At the workshop we heard that whilst there can be complexities in navigating the local health and homelessness sectors, there are good examples of strong and effective local partnership working. These partnerships included a wide range of stakeholders from across the statutory and voluntary sector, such as health, housing and law enforcement agencies, through to volunteer befrienders and peer advocates. Multi-disciplinary approaches were felt to be hugely important and many participants had initiated local review forums to facilitate this.

Other examples of the achievements of local partnerships included:

• Hospices training hostel staff on communication skills and end of life care conversations
• Hostel staff upskilling palliative care staff in the local homelessness sector and supporting people experiencing homelessness
• Analysis of local data to help identify gaps in current provision
• Simplifying local referral processes to ensure these were consistent across a
• local area
• Working together with local pet care organisations to ensure people’s wishes regarding their pets can be fulfilled
• Reflective practice and bereavement support for people working in hostels.

The workshop also identified some key elements of successful partnerships. Effective communication is crucial, along with a strategic commitment to the partnership to overcome staff turnover, changes in services, etc. Many of these partnerships had been driven by a homelessness ‘champion’ or coordinator in palliative care services, able to share information, network and do outreach work locally. It was also clear that it is important not to become overwhelmed by the scale of the issue: making small steps to improve end of life care for people experiencing homelessness makes a real difference.

Overarching principles for success

The case studies presented within the publication invite readers to explore different approaches to delivering and embedding personalised end of life care for these groups. It was evident that the foundations of success rely on the implementation of five key principles. The principles can be used by all professionals working with people nearing end of life, including nurses, who are often the closest to the individuals and their families and carers:

1. Good communication which includes engaging with people in a way that is meaningful for the individual and so enables people to make informed decisions about their care;
2. An approach founded on dignity and respect, and investing in a relationship of trust;
3. The provision of workforce training and support;
4. Enabling partnership working at a strategic level;
5. Recognising that people are all different so inclusive, equitable care is not about treating everybody the same way.

Next steps

During the preparation of this guide, we heard a clear call for more networking to share best practice, experience and ideas. Hospice UK and its partners will continue to facilitate this networking by sharing the guide and the principles of success with relevant audiences to facilitate personalised end of life care for vulnerable groups.

Melanie Hodson, Hospice UK & Caroline Bernard, Homeless Link

References

Department of Health (2016). Our commitment to you for end of life care: the Government Response to the Review of Choice in End of Life Care. London: Department of Health. Available from: www.gov.uk/government/publications/choice-in-end-of-life-care-government-response

Shulman C, Hudson B, Brophy N. (2018) Improving access to palliative care for people who are homeless. 22 Oct The QNI Blog [Online] Available from: www.qni.org.uk/2018/10/22/how-can-we-address-the-inequality-of-access-to-palliative-care-services-for-people-experiencing-homelessness

Tackling Inequalities in End of Life Care for Minority Groups VCSE Health and Wellbeing Alliance Project Group (2018). Care committed to me. Delivering high quality, personalised palliative and end of life care for Gypsies & Travellers, LGBT people and people experiencing homelessness: a resource for commissioners, service providers and health, care and support staff. London: Hospice UK, on behalf of the Tackling Inequalities in End of Life Care for Minority Groups VCSE Project Group. Available from: www.hospiceuk.org/policy-advocacy/policy-priorities/tackling-inequalities-in-end-of-life-care