Issues for people experiencing homelessness
It was estimated that on census night 9 August 2011 there were 105,237 people who were homeless, or 0.5% of the Australian population. 60% of homeless people were aged under 35 years, compared to 46% for the general population. [1]
Many older homeless people are invisible as are those who are rough sleepers and missing persons, so accurate figures are difficult to obtain. [2]
Common issues
People who are homeless and require palliative care usually lack an adequate site to receive care, as they may move around within shelters or on the street. This makes the assessment of daily needs difficult. They may also be unable to attend appointments, so accident and emergency departments are often the site of care.
Homeless people often have co-morbidities, including mental health and behavioural problems and alternative lifestyles such as illicit drug use, alcoholism or prostitution can also impact. They may have little social support, no medical insurance, and little financial capacity, so healthcare will not always take priority. When receiving treatment, issues such as lack of storage facilities for medications and problems with theft of medications need to be considered. Patients may be tempted to barter medications for food or other needs. Compliance can be low, and low literacy can contribute to this.
Most approaches to care look at partnership models between health and community services, such as housing and justice health. Palliative care services need to identify and work alongside local homeless services, as well as local health and nursing services.
Many people experiencing homelessness will not have made a will or if they do, it could have been prepared long ago and is perhaps lost. Having a will can help in locating next of kin, and in decisions regarding after death care. Identifying next of kin is important for many reasons. Not having someone to contact could delay a transfer to a hospice. It is also difficult if there are no financial arrangements in place regarding the funeral. It is important that a contact person is identified even if the patient doesn’t want them involved until after death.
Some people may be wary of information being shared with their next of kin or contact person, so confidentiality will need to be maintained. Staff in hostels and supported accommodation, or health professionals may end up as surrogate decision makers and so need support in that role. [2]
After death, the next of kin may or may not want the responsibility of the funeral and a social worker may need to be involved.