People who are homeless and facing the end of their life

    As Dying Matters Week comes to a close, Niamh Brophy, St Mungo’s Palliative Care service – the only one of its kind in the homelessness sector in the UK – explains more about how the service helps people the end of their lives.

    Last week I met John. He is 65 and has been intermittently homeless since his marriage broke down in 2009. The trauma of losing his family meant John lost control of his life. He ended up on the streets before coming to live in one of our hostels.

    When John was diagnosed with cancer a few weeks ago it came as a shock not only to him, but to the staff and residents of the place that had been his home for the past eight years.

    I also met Stephen, his support worker, who helps him in many ways, and who is doing his best to help John do what he wants to do with the rest of the time he has.

    The link between homelessness and health is widely recognised. Our wider understanding of the experiences of homeless people dying on the streets, in hostels or in hospital remains patchy.

    People experiencing homelessness have a much higher likelihood of having a long term health condition. Illnesses can often go undetected and untreated over time if people are reluctant to engage, because of other priorities they may have around being homeless. Care can then often become crisis led, particularly if further compounded with alcohol or drug use and worsening mental health.

    A consequence of this ‘non-engagement’ is demonstrated most shockingly in the statistic for the average age of death for someone who’s been homeless: 47 for men, 43 for women.

    St Mungo’s Palliative Care service

    It should not come as a surprise to hear that most homeless people do not gain access to palliative care until very late in their illness, if at all. Often their choices for care are limited, and their death is more likely to be perceived as sudden, untimely and undignified.

    In 2007, St Mungo’s started working to address these issues and improve care services for residents with advanced ill health.

    Our service aims to give our residents with serious health concerns the opportunity to choose their treatment, the chance to reconnect with loved ones, and the possibility to die in a dignified, comfortable way in a place of their choosing.

    We do this in five different ways:

    • Support residents to make informed choices about future needs and wishes and ensure access to supportive services, including specialist palliative care;
    • Support residents and staff in dealing with the psychological and emotional aspects of approaching the end of life;
    • Provide appropriate training to frontline staff in dealing with end of life issues, including bereavement support and spotting when clients may be at risk of dying;
    • Provide bereavement support to frontline staff and residents through a volunteer-led bereavement befriending service;
    • Work in partnership to raise awareness of the end of life care needs of people who are homeless.

    Since the service started a decade ago, we have:

    • Provided more than 190 residents with end of life care support including bereavement support. This created opportunities for residents to stay longer at home, feel supported emotionally, as well as allowing them the opportunity to make their wishes and preferences known.
    • Delivered training about homelessness and end of life care to more than 300 staff, including training sessions tailored to the specific needs of our individual projects. This has enabled staff to feel more confident in identifying those who may benefit from support.
    • Developed an online resource pack aimed at supporting staff working with people who are homeless.
    • Forged greater links and partnership working with services such as a multidisciplinary working group set up to identify earlier on those residents whose health may be deteriorating. This involves the local alcohol service, GP, hostel and hospice staff and is chaired by the Palliative Care Coordinator.
    • Partnered on collaborative research and training development with UCL, Marie Curie and Pathway that explores the challenges of palliative care for homeless people and how best to overcome them.

    In the UK, according to the Economist Intelligence Unit, we provide the best end of life care in the world. Providing end of life care for people, like John, who are homeless brings unique challenges. (Here’s a link to more information)

    We must work to ensure best practice is extended to all members of our society, particularly those vulnerably housed who all too often fall through the cracks.

    How you can help

    If you’re interested in the work we do to help our clients and want to do more, here’s how you can get involved:

    Ref: Economic Intelligence Unit. The quality of death: Ranking end-of-life care across the world. 2010

    Transatlantic practice exchange…the countdown has begun

    St Mungo’s Housing First worker Louisa has been selected to travel to Los Angeles as part of the Transatlantic Practice Exchange. She tells us about how she’ll be using the experience to bring back fresh ideas and approaches to help in her work ending homelessness.

    I’m finding it hard to believe that I will be flying out to Los Angeles, California, USA, this Sunday 7 May!

    I am lucky enough to be taking part in the Transatlantic Practice Exchange. The Exchange is an exciting opportunity for myself, as a representative of St Mungo’s, and four other frontline staff from services across the UK to spend a fortnight in the United States, exploring different practice topics and sharing learning on our return. Similarly, services in the UK have volunteered to host five participants from the US. The exchange is a collaboration between Homeless Link in the UK and the National Alliance to End Homelessness in the US and is funded by the Oak Foundation.

    I have been a Housing First Worker at a St Mungo’s North London Housing First service for a year and a half now. Housing First works with people who have been homeless for long periods of time, and who have complex and varied needs. We provide them with a tenancy, intensive support to maintain that tenancy, and to make other positive changes in their lives.

    ‘Rebuilding shattered lives’

    When I started at St Mungo’s Housing First I was amazed at the different ethos and approach, and the great outcomes that had been achieved. With a background working in specialist services for women, and a keen interest in gender studies, I became interested in homeless women’s experiences of services, especially as their needs can be different to those of homeless men.

    The innovative research carried out by St Mungo’s in their ‘Rebuilding Shattered Lives’ report has highlighted how women are likely to have experienced sustained trauma, abuse and violence throughout their lives, have lost contact with their children, have complex and untreated mental and physical health issues, as well as myriad of other interrelated issues. This inspired me to start a project to find out more about the needs of women accessing our Housing First service, what we were doing well and where the challenges lay. So when the opportunity to take part in the exchange came up, I knew exactly what topic I wanted to focus on.

    ‘An intense but fascinating two weeks of learning’

    On Monday morning, probably fairly dazed and half asleep, I will make my way to my host organisation, Downtown Women’s Centre, on Skid Row in Downtown LA, to meet chief programme officer, Amy Turk, and begin what will be an intense but fascinating two weeks of learning. The Downtown Women’s Centre has a well-established housing first service for women, with 119 on site apartments as well as a community based housing programme. They also run an incredibly busy day centre, where 200 women a day take a shower, get meals, clothes and advice, and access health and trauma recovery services.

    I have more questions to ask than I can count! I have done so much reading on Housing First and the context of homelessness in the US I feel finally ready to get out there and experience it first-hand.
    I will be sharing reflections and some of my experiences with you in a short series of blog postsat,, and I will be tweeting about it here, See you on the other side!


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