Caring for the terminally ill in a respite setting: The challenges to providing care

APHA Scientific Session and Event Listing

Monica Bharel, MD and Sarah Ciambrone. Barbara McInnis House, Boston Health Care for the Homeless, 461 Walnut Ave, Jamaica Plain, MA 02130, 617-488-1782, mbharel@bhchp.org

Caring for the terminally ill in a respite setting: The challenge to providing care

Background: Homeless individuals face many challenges in accessing adequate medical care. These challenges are enhanced when a homeless individual is facing a terminal disease. The Barbara McInnis House 90-bed respite unit, of Boston Health Care for the Homeless, provides a dignified, personalized, medically staffed program for these patients.

Methods: Over the past year we have provided end of life care for five homeless individuals. Each individual was selected based on their need for end of life care when resources in the mainstream medical system were not available. Each patient was provided with individualized care. Each case was reviewed by us and the challenges and successes of each circumstance were analyzed.

Results: The respite setting provided a successful alternative to the street and shelter system for dying homeless patients. All appropriate services were provided to the individuals. These included a “home” for the dying patient, appropriate medical and nursing care, and the appropriate social support, including spiritual support, funeral planning and allowing for a personalized journey.

Conclusions: It is possible to provide end of life care to dying homeless individuals in a respite setting. The challenges and rewards are immense and each case calls for an individualized approach and flexibility. It is possible to provide end of life care to homeless individuals in a compassionate way that preserves dignity and a sense of autonomy.

Learning Objectives:

Participants will learn

1.To compare and contrast the differences between the age, causes, place, and type of death of homeless individuals on the streets, shelter and other settings compared to the population at large.
2.Homeless death reviews from around the country and hear about stories from street, shelter and respite care.
3.Terminology to understand end of life care
4.Review the known literature on death and dying in the homeless
5.Understand the challenges to providing care to the homeless dying in a respite center

Keywords: Homeless Health Care,

Presenting author's disclosure statement:

Any relevant financial relationships? No

Services to Support the Health of Individuals Experiencing Homelessness

The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA