References
Are district nurses well placed to provide equitable end-of-life care to individuals who are homeless?
Abstract
This literature review aimed to answer the focus question: are district nurses well placed to provide equitable end of life care (EOL) for homeless individuals? It focused on 10 primary research studies, from which two themes emerged and subsequently formed the basis of the discussion: (1) the difficulty in predicting disease trajectory in people who are homeless and (2) the gaps in existing systems. The main findings from these themes were a lack of education on the recognition of the dying and a general lack of knowledge of the complex challenges faced by and health needs of homeless people, which cause stigma from both the general public and health professionals towards these marginalised individuals. Further, there is certainly a lack of suitable places to deliver palliative and EOL care for people who are homeless. Available services are inflexible and have no tolerance for substance misuse, which creates an access barrier for homeless people in need of EOL care.
The homeless population in the UK is growing, and yet homelessness is a vastly under-reported problem (Reeve, 2011). According to recent estimates from the Ministry of Housing, Communities and Local Government (2019), around 4677 individuals sleep rough in England on any given night. However, these figures only include ‘rough sleepers’ (people who are sleeping on the streets) and do not include those who are staying with friends or ‘sofa surfing’. An analysis by Homeless Link (2018) shows that although there has been a 2% decrease in figures between 2017 and 2018, there has been an overall increase by 165% in the number of rough sleepers since 2010. In its annual review, combining government and local authority figures on rough sleeping, temporary accommodation and social services, Shelter (2018) estimated that the actual number of homeless individuals in Britain today is around 320 000.
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