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Opinion

Why are homeless people still dying without dignity?

Hundreds of people die while experiencing homelessness in the UK. Where death can’t be prevented we must ensure they die with dignity, writes palliative care expert Andrew Knee.

Last month, mourners gathered at St Martin-in-the-Fields church in central London, as the names of 116 people who died in the English capital while experiencing homelessness were read aloud. Friends and colleagues from across the homeless sector came together in grief, and to remember those whose untimely deaths may otherwise go unnoticed and ignored.

Death is a fundamental part of life that affects us all, but for many people living on the streets or insecurely housed, it comes too early and often from preventable causes. Deaths within the homeless population are often sudden and undignified, with access to palliative care being rare.

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New figures released today by the Office for National Statistics highlight the sad reality that 688 people lost their lives while experiencing homelessness in England and Wales in 2020. The average age of death for a man experiencing homelessness is 45 years of age and is even lower for women at just 41.

As the palliative care coordinator for St Mungo’s, I can see that this endemic issue is widely known by organisations like ours, but rarely given much thought by those with minimal or no experience working with this disadvantaged group.

Homelessness is not just a housing issue, but a health one and poor health is both a cause and consequence of homelessness. After spending years on the streets or in unstable accommodation, many of the clients we support at St Mungo’s have multiple complex needs including mental health, substance use, and physical health issues.

We ran 30 emergency hotels during the pandemic, and almost a fifth of clients were not even registered with a GP when they moved in – a harsh statistic to digest.

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Sadly those who experience homelessness have often felt abandoned and disenfranchised by services in the past and so are less likely to try and get help, even when they are not feeling well. In the event they do reach out to a GP surgery, all too often people are turned away as many practices assume, wrongly, that they require an address to register. 

That’s why it’s vital that we work together with agencies and support services to improve the health and wellbeing of our clients. But where someone’s death can’t be prevented, we also have a responsibility to help them approach the end of their life with dignity, care and respect.

This is where our palliative care service steps in. St Mungo’s is the only homelessness organisation to have dedicated provision to support clients who have a terminal prognosis, or acute health conditions, to protect their quality of life, and help them to ‘live well’ until they die.

Our model of care is simple; we work with our support and accommodation services to bring in the right professionals to provide multidisciplinary specialist support in a holistic and person-centred way. Making sure the individual is always at the heart of their care.

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Any death is difficult, and I’ve seen many people come into our services who, having lost contact with their own families, come to see our staff and clients as their family. Consequently, when someone is diagnosed with a terminal illness they may choose to live their final days in a hostel, and by working with our staff and local hospices, we try to make this wish a reality. Importantly we’re not only preparing the individual for death, but also giving those around them emotional support and training in how to have, what are often, difficult conversations.

As we adjust to the ‘new normal’ following the pandemic, statistics show that the number of people sleeping rough on the streets of the capital is rising. Someone once told me that by accepting death, they were able to embrace life – the right support can help people do this, and that’s why high-quality, personalised palliative and end-of-life care should be accessible to everyone.

It’s important we work together to ensure that no death goes ignored. I’m proud to have contributed to ‘Homeless, young and dying: we can do better’; a new short film that shines a spotlight on how organisations across the homelessness, housing, health and social care sectors can make positive changes towards helping those in need.

We want to see equity of care, with new ways of working to break down barriers. This includes taking services to people via hospice outreach work, and in-reach to homeless sector services. It also means training staff and empowering them to support clients, ensuring there are peer advocates to improve client engagement with health services, and offering palliative and end of life care as part of the wrap-around support offered via the Housing First programme.

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It’s our duty to turn fear into hope. By focusing only on someone’s death, rather than supporting them to live well during their final months and days – you are abandoning that individual. We have a responsibility to ensure that all people experiencing homelessness can be supported and cared for in a way that gives them dignity, both in life and death. Everyone, no matter your circumstances or history, deserves to die with dignity and respect.

Andrew Knee is palliative care coordinator for the homelessness charity St Mungo’s. The short film, ‘Homeless, young and dying: we can do better’ is available to watch here.

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