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Palliative Care in a Hostel Setting: Challenges and Solutions

This article explores the challenges of delivering palliative care in a hostel setting and provides solutions for addressing these challenges. It highlights the complex needs of homeless individuals and the importance of parallel planning and good communication. Case studies illustrate practical considerations and strategies for supporting clients in a hostel environment.

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Palliative Care in a Hostel Setting: Challenges and Solutions

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  1. Delivering Palliative Care in a Hostel Setting Catherine Hedges

  2. Palliative Care at St Mungo’s We support men and women through more than 300 projects The palliative care coordinator supports clients and staff across the organisation We provide a bed and support to more than 2,700 people a night who are either homeless or at risk The befriender service support clients who are at risk of dying, or who are grieving and in need of bereavement support. They also support St Mungo’s staff and teams where a client has passed away We work across London and the south of England

  3. Dying as a homeless person Deaths are often sudden, untimely and undignified, with access to palliative care being very unusual (Crisis report 2012) Thomas B. Homelessness Kills: An analysis of the mortality of homeless people in early twenty-first century England. London Crisis; 2012.

  4. The Challenges Caring for clients in a hostel setting

  5. The Challenges Complex Clients Hostel Setting The Topic Knowledge

  6. The Hostel Environment Three tools for planning ahead… • Check out Sample Advance State

  7. Knowledge Lack of confidence Unaware of the impact on staff Lack of specialist knowledge The rapid changes of the client’s condition

  8. Complex needs of the client Tri-morbidity Mental health 45% had mental health diagnosis Drug and pain management Negative perceptions from professionals Physical health Substance use 60% history of substance misuse Denial of prognosis

  9. Interacting with the topic Having conversations about deteriorating health Complexity of need Removing hope Saying the wrong thing Dealing with difficult questions Our own feelings about death Uncertain illness trajectories Non-engagement Client reaction Fearful of damaging your relationship Not feeling qualified Lack of options

  10. Counteracting the Challenges

  11. Working through the challenges Parallel Planning Good Communication Partnership working Start early

  12. Information sharing Communication Coordinated Care planning

  13. Parallel Planning Aims Examples Encouraging goals and interests Exploring hopes for the future Supporting to attend care assessment Hoping for the best Planning for the worst If there’s another hospital admission, what should we do? Family reconnection? Does he have questions and would like to speak to his GP?

  14. Planning ahead for end of life. Making sure the clients wishes are respected Organ donation Befriender Service • Making a will/sorting out finances Advance Statement of Wishes Emotional/ Psychological needs • Funeral wishes Decisions about their death Family Reconnection • Place of Care Refusing treatment (ADRTs) Friends/ Community Preferred place of death

  15. Case Study Caring for clients in a hostel

  16. Laura • Aged 36, heavy substance user (crack & heroin – smoked) since a young age with a history of sex working • Dependence on butane gas, will use 10+ a day • History of trauma (rape, domestic violence) and mental health (self-harm, depression), estranged from family • Spent many years sleeping rough, and was placed in a hostel after an serious sexual assault incident • Multiple admissions to hospital, continuously self-discharges with multiple serious health issues (Hep C, HIV, increased risk of infection) • Laura’s care needs are increasing (frail, extra support from staff, episodes of incontinence, not eating unless food is provided by staff), will disappear for multiple days • Laura was on a methadone script, but has since disengaged with the local services

  17. Consider The Challenges What challenges can you identify working with Laura? Working through the challenges What would put in place to support Laura, keeping parallel planning in mind. Use the Planning care home tool if it is helpful.

  18. Planning care at home tool Practical considerations (H&S, mobility, equipment) Domestic & Personal Care (meals, hygiene) Medical (scripts, storage, nurse access etc.) MDT considerations Impact on other clients Staff support Laura

  19. Regular review of risk assessments, ground floor room/lift, fire evacuation plan, transport/arrangements for appointments Practical considerations (H&S, mobility, equipment) Full package of care, equipment and resources (disposable bedsheets), community support, entitlement to additional benefits i.e. DS1500 Domestic & Personal Care (meals, hygiene) Lockable cabinet in client’s room, pharmacy daily pickup/drop off, key safe installed Medical (scripts, storage, nurse access etc.) MDT considerations Client meetings, emotional support available, risk assessments reviewed Impact on other clients Staff support Regular MDTs, in reach support (service mapping), emotional support Emotional support, family reconnection, spiritual needs, wishes and preferences for care Laura

  20. Adam • Aged 53, historical substance user (crack & heroin – IV) since being in the army • Detained in a immigration detention centre, but won case for right to remain • History of PTSD • Spent many years sleeping rough, and was placed in a hostel after being discharged to streets upon receiving terminal diagnosis of pancreatic cancer • Adam has a dog who has been his companion on the streets for over a year • Prognosis of 6 months to live • Adam has additional care needs (stoma, mobility issues) • Does not want to die in hospital • Has not seen his family in 10+ years

  21. Who can support us

  22. End of Life Care – project checklist Professionals involved in care

  23. Supporting clients: Do’s & Don’t’s Do…… Familiarise yourself with, and talk to clients about, the nature of loss and grief reactions in bereavement or when facing a terminal illness (e.g. toolkit/CRUSE, Us) Encourage clients to express their feelings and not be afraid to express your own where appropriate Involve clients in funeral arrangements and celebrations Be available to listen or to help when you can Continue to affirm dying as a normal process For bereavement, continue to acknowledge loss months after a death Don’t…… … feel that you are there to resolve client’s grief … let your own sense of helplessness keep you from reaching out … tell them what they should feel or do … change the subject when they bring up their illness or loss … assume that just because months have gone by that everything is ok

  24. Questions to consider

  25. Useful tools Hospice UK www.hospiceuk.org Marie Curie www.mariecurie.org.uk Compassion in Dying Compassion in Dying have resources to help explain and write an advance care plan. www.compassionindying.org.uk Palliative care co-ordinator at St Mungo’s Palliativecare@mungos.org Homeless Palliative Care Toolkit www.homelesspalliativecare.com Dying Matters www.dyingmatters.org Macmillan Learnzone Free learning resources, online courses, and professional development tools from Macmillan Cancer Support www.learnzone.org.uk

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