Case study:

06 December 2010

Raising the subject of approaching death in a hostel

Key points

The homeless hostel at 32 Bentinck Road, Nottingham offers long-term care and support for 21 residents, all of whom are 50 or over. One of the most difficult issues for staff is raising the subject of someone’s approaching death.

Most of the hostel’s residents were previously homeless and although some improve and move out, many others stay there till they die.

Manager Dave Milburn and his fellow members of staff will not usually be the ones to break the bad news in the first place. But immediately afterwards they will be deeply involved in trying to help their clients focus on how and where they wish to spend their remaining time.

Mr Milburn says the important thing at this stage is to have an honest and realistic dialogue. “I often encounter a degree of shock from the individual that at the age of, say, 50 they are dying. They say: ’How did I get here?’”

One of the keys is trying to connect with the individual and their particular tragedy. “They didn’t plan for this way of life. It’s invariably happened because of a series of misfortunes and sadly, in many cases, unwise decisions and you need to be able to understand this.”

It is vital to get the timing and the tone of this conversation right. Often there will be a chance after someone has been told they have a terminal condition to sit down over a drink and ask them where they want to go from here. Most people seem to want to engage with that, he says.

Mr Milburn says he tries to talk about practical matters as well as people’s priorities. He also looks for catalysts such as, for instance, someone choosing a ‘weepie’ DVD that may offer an opening to talk about what’s going on in their lives.

He notices a mood of “quiet observance” when someone is dying within the home. “The whole home feels it when that happens. It’s just in the air. And it’s something that has to be respected.”