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O-8 When dying at home is not an option: an exploration of the perception of hostel staff regarding the provision of hostel-based palliative care to homeless people

Background There are many complexities surrounding palliative and end of life care for homeless people (Help the Hospices 2012). Presently, the Department of Health (DoH 2010) is suggesting that hostel staff are the most appropriate key-workers for their dying homeless residents and that hostel based palliative care may be the best way forward. However, little is known about the views of hostel staff with regard to this. Methods Semi-structured qualitative interviews of up to one hour were conducted with seven participants working in four hostels across three UK counties. A total of 37 specific case studies were shared by the seven participants. The case studies involved homeless residents with a wide range of life-limiting or palliative conditions. Findings Eight main themes emerged: understanding palliative care; working with limited medical information; taking responsibility; building rapport; upholding resident’s dignity; recognising physical deterioration; managing environmental challenges; role limitations and support needs of hostel staff. Conclusion Discussion centred around the following four sub-headings: the policy, principles and practice of palliative care; professional boundaries as a threat to holism and a hindrance to dignity; the social undesirability and invisibility of homeless people; ‘community living’ as a barrier to hostel based palliative care and a new concept of family.