End-of-life care for homeless people in shelter-based nursing care settings: A retrospective record study

Abstract

Background: Homeless people experience multiple health problems and early mortality. In the Netherlands, they can get shelter-based end-of-life care, but shelters are predominantly focused on temporary accommodation and recovery. Aim: To examine the characteristics of homeless people who reside at the end-of-life in shelter-based nursing care settings and the challenges in the end-of-life care provided to them. Design: A retrospective record study using both quantitative and qualitative analysis methods. Setting/participants: Two Dutch shelter-based nursing care settings. We included 61 homeless patients who died between 2009 and 2016. Results: Most patients had somatic (98%), psychiatric (84%) and addiction problems (90%). For 75% of the patients, the end of life was recognised and documented; this occurred 0–1253 days before death. For 26%, a palliative care team was consulted in the year before death. In the three months before death, 45% had at least three transitions, mainly to hospitals. Sixty-five percent of the patients died in the shelter, 27% in a hospital and 3% in a hospice. A quarter of all patients were known to have died alone. Documented care difficulties concerned continuity of care, social and environmental safety, patient–professional communication and medical-pharmacological alleviation of suffering. Conclusions: End-of-life care for homeless persons residing in shelter-based nursing care settings is characterised and challenged by comorbidities, uncertain prognoses, complicated social circumstances and many transitions to other settings. Multilevel end-of-life care improvements, including increased interdisciplinary collaboration, are needed to reduce transitions and suffering of this vulnerable population at the end of life.

Evaluating the perceived added value of a threefold intervention to improve palliative care for persons experiencing homelessness: a mixed-method study among social service and palliative care professionals

“…In social service facilities, somatic issues among persons experiencing homelessness are presented and regular deaths regularly occur. So-called street nurses provide this care, these are often generalist nurses who have a long history of working with this population [ 11 , 12 ]. The age at death of the homeless population is approximately 10 to 30 years younger than for the housed population [ 13 – 19 ].…”

Facilidades e dificuldades no acesso aos cuidados paliativos por populações em situação de rua e LGBTQIA+: revisão integrativa

“…Zimbabwe 9 teve um estudo publicado e houve um estudo multicêntrico, 42 entre EUA e Canadá. As revistas em que mais os autores publicaram foram Palliative Medicine, 9,29,37,39 BMC Palliative Care 10,30,33,34 e Journal of pain and symptom management. 14,15 A área de publicação que mais discorreu sobre o tema foi a Medicina, 10,14,15,30,32,36,39,42 seguido da Multidisciplinar 9,28,29,31,34,35,38 e da Enfermagem.…”

“…6,10,14,15 Os cenários mais frequentes foram abrigos/ albergues, 29,30,33,39,41 unidades de internação hospitalar, equipe de consultoria, hospitais e unidades básicas de saúde. 12,14,28,29,32,33,35,37,40,42 Quanto ao desenho metodológico, 18 artigos se utilizaram de abordagem qualitativa 6,9,10,12,14,15,29,[30][31][32][33][34][35][36][38][39][40]42 e três de quantitativa. 28,37,41 A entrevista foi a técnica de produção de dados mais utilizada, 9,29,[30][31][32][33]35,36,[38][39]…”

“…12,14,28,29,32,33,35,37,40,42 Quanto ao desenho metodológico, 18 artigos se utilizaram de abordagem qualitativa 6,9,10,12,14,15,29,[30][31][32][33][34][35][36][38][39][40]42 e três de quantitativa. 28,37,41 A entrevista foi a técnica de produção de dados mais utilizada, 9,29,[30][31][32][33]35,36,[38][39][40]42 seguida de grupo focal 9,14,36,38,39 e revisão de literatura. 6,12,15,…”

“…28,37,41 A entrevista foi a técnica de produção de dados mais utilizada, 9,29,[30][31][32][33]35,36,[38][39][40]42 seguida de grupo focal 9,14,36,38,39 e revisão de literatura. 6,12,15,31,34 Em relação à população específica abordada, 15 estudos contemplaram a população em situação de rua 10,12,14,[30][31][32][33][34][35][36][37][38][39][40]42 e seis a população LGBTQIA+. 6,9,15,28,29,41 Após a análise e interpretação dos dados, duas unidades temáticas foram construídas:…”