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: You could volunteer at one of our projects, Donate Campaign for us Ref: Economic Intelligence Unit. The quality of death: Ranking end-of-life care across the world. 2010
Save Hostels. Rebuild Lives.
This week, St Mungo’s launched our Save Hostels Rebuild Lives campaign, calling on the government to properly consider the damaging effect changes to funding for supported housing could have on homeless people. Take five minutes to find out why, and what you can do to help. Many people who are homeless or at risk of homelessness need specialist support. This expert support is provided by dedicated staff in supported housing – hostels – but these services are at risk. The Secretary of State for Communities and Local Government, Sajid Javid, and Secretary of State for Work and Pensions, Damian Green, are planning to present proposals to change funding for supported housing to government in a matter of months. St Mungo’s believes these changes will cause irreparable damage to essential services and may even cause some to close. A route out of rough sleeping Full disclosure? We provide supported housing services that could be affected by current proposals, which will compound problems faced by projects already being challenged by a reduction in rent allowance that came into effect in April 2017. In 2016, St Mungo’s housed 4,120 people, over half of whom have slept rough. Many of our clients have multiple and complex needs, and for them, recovery is more than a roof. Most funding for supported housing services for single homeless people comes from a combination of housing benefit and local authority budget for support they commission. Supported housing under threat The proposals involve reducing people’s benefit entitlement, but they don’t take into account the way support is funded. They will leave supported housing services even more reliant on entirely discretionary funding from already stretched local council budgets. With no legal requirement to provide vulnerable homeless people with supported housing, many services have lost their funding. Analysis by the National Audit Office shows that between 2010/11 and 2014/15 funding for housing-related support fell by 45% across single-tier and county councils. [1] There are many reasons to be concerned by this. One argument is that without the right support at the right time, people can get stuck in damaging cycles of homelessness, making recovery all the more difficult. Another is that causing the reduction of available places in supported housing makes no economic sense. The existing proposals suggest a cap on housing benefits based on local housing allowance rates, which is tied to rent levels in the private sector. This does not take into account the reality that the costs of providing supported housing are similar across the country. St Mungo’s believes that basing the system purely on Local Housing Allowance rates will provide little incentive to develop supported housing for homeless people in low rent areas. This would create a situation whereby availability of supported housing could be limited in places where it would be easier for residents to find affordable housing when they are ready to move on. A funding system that does not take into account local demand – or does not ensure that need is properly assessed – not only ruins lives, it is more expensive. Research published by the National Housing Federation found a shortfall of 16,692 places in supported housing for working-aged people in 2015/16. The research estimated that in the last financial year, the shortfall in supported housing places cost the taxpayer £361 million. [2] The right support for recovery “Making the service fit the need is really important.” – Rob Rob told me how he spent 20 years bouncing between sofas and services ill-equipped to help him recover and properly manage his mental health. Finally, he came to a service we run that worked for him. He’s since moved into independent living, is engaged to be married and is working as an advocate for homeless people. We know that sometimes people find certain environments challenging. Sometimes, people move between services because their support needs have changed or because services close. Recovery is a process, and moving into supported accommodation after living on the streets can be a difficult transition, but these services save lives. We are urging the Secretaries of State for Communities and Local Government and for Work and Pensions to: Develop a sustainable and secure new funding system that helps vulnerable people get off the streets for good Introduce a legal requirement for local authorities to assess need and plan for appropriate supported housing provision in their area Ensure that the system is fully transparent and accountable to central government With the right support at the right time, people can recover and rebuild their lives after being homeless. [1] National Audit Office (2014) The impact of funding reductions on local authorities [2] National Housing Federation (2017) Strengthening the case for supported housing
Five ‘giant evils’ of 1940s still exist for today’s homeless
The welfare state was established to fight the five ‘giant evils’ Lord Beveridge identified in his 1942 report. 70 years on, is the welfare state just as spritely when it comes to vanquishing those giant evils? Denis, from St Mungo’s client representative group Outside In, doesn’t think so: “The five evils are still evils in today’s society. They still continue.” Tanya English, St Mungo’s Executive Director of Communications, examines some client perspectives and considers our response… Giant evil #1: Squalor Beveridge wanted to break the cycle of poverty, where health problems caused by inadequate housing restricted people’s ability to work. Today, thousands of people still end up sleeping on the streets each year: “On many occasions I woke up and I’ve been covered in snow” Mark, 37 “When I woke up sometimes, my foot would be so frozen that I wouldn’t move it until it proper thaws out because it felt like I had frost bites and my hands were hurting because it was so cold” Michael, 31 Giant evil #2: Ignorance Beveridge thought that higher social classes were ignorant of the problems affecting communities. Our clients still experience this prejudice: “[Homeless people are] treated bad. Low life, dirty junkie, prostitutes, worthless dogs, but we’re not. We haven’t committed a crime; we’ve just had a bit of bad luck and made a terrible mistake, you know?” Linda, 52 “I think people who have problems with the homeless…whatever problems they’ve had, however they end up that way; I personally think [people] should consider them a bit more. Whether you’re homeless or not you’re still human beings at the end of the day. We are all still human beings.” Leon, 36 Giant evil #3: Want Beveridge was concerned with ensuring everyone in society had what they needed to survive. Unfortunately, many people who are homeless feel they have to resort to crime just to be able to eat: “[Homelessness] actually turned me to crime and…I’m a bit ashamed because I’ve caused a lot of damage to properties having to steal lead and that was just to survive… when you get your dole money if it doesn’t last or you get robbed, you’re going to find it very, very, very hard. I found that very, very difficult to, you know, to get a meal most days.” Stuart, 44 Giant evil #4: Idleness Beveridge called for training and work centres to be set up across the country to help everyone find a job. Although many people who are homeless would prefer to work, many still struggle with overcoming bureaucratic hurdles: “[When] you do go for a new job you say, ‘I’ve been homeless; this is why I’ve been out of work’, they just say, ‘What have you been doing?’” Michael, 30 “I was at the job centre. Loads and loads of work, but it was the same answer every time I picked the phone up, ‘We need proof of your address in London’” Jason, 39 Giant evil #5: Disease Beveridge believed that tackling health issues was central to helping people out of poverty. Health is a significant barrier to work for a number of people who we help: “I’ve nearly been killed three times doing [prostitution]. I’ve been raped doing it. I’ve… as a result of that I got HIV doing it.” Angela, 38 “Some people don’t understand [depression]… A lot of the time I have kept myself to myself. It’s only recently I’ve started to push myself out there a bit more. But even still there’s stigma. Any hint that you’ve got this, especially when I’ve been in the mental hospital, people think straight away strait jackets; nutjob.” Michael, 30 At a time of great financial uncertainty, Britain’s welfare system was set up to direct limited resources towards those who needed them most. Now in the middle of another financial crisis 70 years later, those who are most vulnerable are still tumbling through the gaps in the safety net to the streets below. Our response must be to strengthen the net, not cut more holes.
