Case study:

06 December 2010

First palliative care service for homeless people

Key points

The homeless charity St Mungo’s together with Marie Curie have set up the first palliative care service in the UK for homeless people with terminal illnesses. One of the chief aims is to enable clients to make informed decisions about how they would like to be cared for until they die.

Other aims of the service, which has been operating since September 2009, are:

• Respect for an individual’s cultural attitudes about death, enabling them to die with dignity
• Helping to deal with the psychological and emotional aspects of coming to the end of life
• Death occurring in the environment chosen by the service user.
  The service is led by Palliative Care Co-ordinator Peter Kennedy whose role is to co-ordinate care between the resident, significant others, community palliative care services, medical consultants and St Mungo’s staff. He also provides training and support to hostel staff.

  Many residents’ illness trajectories are difficult to predict, he says. Over 90% of deaths in St Mungo’s projects are perceived as “sudden”, although not necessarily unexpected. It is also difficult to assess the severity of people’s illness, particularly those with advanced liver disease. The average age of death among residents in St Mungo’s projects is 46.

  Another challenge is that many clients approaching the end of their life have mental health and substance use problems. Working in partnership with statutory and non-statutory agencies is paramount in meeting the multiple needs of those clients, says Mr Kennedy.

  The service’s first step is an initial assessment to see if a client meets the end of life care criteria. The question, “would I be surprised if this person was to die within the next 6 to 12 months?” can help staff identify early on if someone is approaching the end of their life.

  Once a client is seen to meet the criteria, the service can then begin to explore their understanding of what is happening and their preferences and wishes. Clients need to be told about appropriate support, particularly specialist palliative care support for dealing with the different aspects of end of life care. But above all they should remain in control of the choices around end of life issues, however difficult that is for staff.

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