Palliative Care Support in People Experiencing Homelessness

People affected by homelessness experience some of the worst health outcomes in society. They face many barriers in accessing services. These can be connected to previous traumatic experiences, poor mental health, and/or substance misuse often compounded by feeling judged or stigmatised when accessing care. Poor understanding about how to manage people with this complexity and a lack of flexibility of services can result in further marginalization and exclusion. This means that many people experiencing homelessness (PEH) die unsupported in undignified situations. Supporting the palliative care needs for people experiencing homelessness requires a multidisciplinary response. Person-centered, trauma-informed approaches, continuity of care, and trusting relationships are key components of good care for this group. Incorporating uncertainty and flexibility into care planning is key, and advance care planning needs to be done in an extremely sensitive way in order to not do harm. A sensitive exploration of insights into illness and what living well means to someone may be the best approach to start to open conversations, with the recognition that this may or may not lead to further conversations exploring wishes regarding the end of life. The ethos of nonjudgmental holistic support that underpins palliative care brings a valuable approach to addressing these needs. Examples of innovation and best practice, which strive to deliver equitable palliative and end-of-life care services, are shared. These highlight the importance of incorporating flexibility and compassion into the delivery of holistic trauma-informed care, in a range of settings.