title: Reaching out to Ray: delivering palliative care services to a homeless person in Melbourne, Australia.
abstract: Most terminally ill people express a preference for dying at home. Within established models of palliative care, achieving death at home is a particular challenge for homeless people. This paper describes a quality-improvement project undertaken by a community-based palliative care service in Melbourne, Australia, to understand homeless people's palliative care needs and the challenges that workers face. Six semi-structured interviews with workers in hospital and community-based settings were undertaken and a case study documented. The results were used to initiate discussion about how policy and protocols for the community-based palliative care service might serve this population more effectively. The findings confirmed that homeless people have complex psychosocial and medical needs. They may be periodically uncontactable or living in unsafe settings, experience isolation from social support networks, and have issues of compliance with treatment protocols exacerbated by mental health problems and/or substance abuse. Service providers had particular challenges in meeting the palliative care needs of homeless people. A flexible, compassionate, and coordinated response is required, and more work is needed to explore how the needs of this particular group can be met.
authors.affiliation: Clinical Nurse Specialist.
authors.forename: Judy
authors.initials: J
authors.lastname: MacWilliams
authors.affiliation: Acting Director, Aged and Palliative Care.
authors.forename: Michael
authors.initials: M
authors.lastname: Bramwell
authors.affiliation: Special Projects, Quality, Research and Education Coordinator.
authors.forename: Sally
authors.initials: S
authors.lastname: Brown
authors.affiliation: Vivian Bullwinkel Chair in Palliative Care Nursing, Palliative Care Research Team, School of Nursing and Midwifery, Monash University, PO Box 527, Frankston 3199, Melbourne, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: O'Connor
mesh_terms: D001315:Australia; D006301:Health Services Needs and Demand; D006703:Ill-Housed Persons; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000451:nursing*; D010166:Palliative Care / Q000379:methods*; D058996:Quality Improvement