When dying at home is not an option: exploration of hostel staff views on palliative care for homeless people

BACKGROUND: The Department of Health in the UK suggest 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 were conducted with seven participants from hostels distributed across three counties. A total of 37 specific case studies were discussed involving 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 residents' dignity; recognising physical deterioration; managing environmental challenges; role limitations and support needs of hostel staff. CONCLUSION: Discussion centred around the following four topics: 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.