Homeless people need better palliative care, finds charity

Homeless people are not receiving adequate end-of-life care because staff working with them cannot spot the signs of advanced liver disease, research has found.

Palliative care training needs to be improved to enable staff to spot the signs of deterioration or impending death and provide appropriate support, stated the report by charities St Mungo’s and Marie Curie Cancer Care.

The report, Supporting Homeless People with Advanced Liver Disease Approaching the End of Life, said that most deaths from liver disease among homeless people were sudden and perceived to be unexpected. Those close to the deceased were often unprepared.

This is despite the fact that most deaths of people receiving care from St Mungo’s each year were associated with liver failure (31 out of 56 deaths in 2009-10), and that this group faced high rates of hospital admission and significant distress in the last six months of life.

Neither homelessness staff, healthcare professionals nor residents found it easy to link the signs of advanced liver disease to palliative care interventions, meaning that residents often did not receive appropriate pain relief, encouraging self-medication with alcohol or drugs.

It said that hostel key workers or substance misuse workers were best placed to recognise when a resident’s condition was deteriorating.

St Mungo’s and Marie Curie Cancer Care have been working together since 2008 to improve end-of-life care for homeless people with the support of a three-year grant from the Department of Health. This has included the appointment of a palliative care co-ordinator at St Mungo’s to provide specialist advice to residents and staff.

The care co-ordinator, Peter Kennedy, said: “Hostel staff are best placed to recognise when a resident’s condition is deteriorating. Most commonly, around two months before death, there can be an increase in jaundice, bleeding, social isolation or a reduction in someone’s self-care.

“This research will help our staff and others to better spot key signals and then to offer the best possible palliative care to that person, while also preparing friends, family and staff.”

Dr Louise Jones, head of the Marie Curie Palliative Care Research Unit, University College London, which carried out the research for the report, said: “Liver failure runs an unpredictable course. It is often difficult to judge when significant deterioration is occurring and the end of life is approaching.

“People who are homeless often have a range of difficulties to face, and best and appropriate care at the end of life for them is as important as it is for any other group.”

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