Day Centres: connecting street homelessness and hospice care

Thursday, 22 June 2017 - 1:53pm

Non-accommodation services can play a significant role in helping people who are sleeping rough, to access end of life care. 

flower dying

Their ability to build compassionate relationships over time can help to ensure that individual’s needs are met by health services, advocating for palliative services to make adjustments in response to complex needs and homelessness. Vivienne Wiggins, chief executive of drop-in and primary healthcare centre Beacon House in Colchester, shares the story of their work with Lee.

At our first encounter with Lee in 2008, he was street homeless and addicted to drugs. Lee had a complex history, with episodes of paranoia and psychosis made worse by drug use. His behaviour was marked by anxiety and fear, which could present as irrationality and delusion. Lee’s despairing view of the world meant that it was, initially, very challenging for the team to convince Lee that we could help to relieve his pain.

Lee had experienced apathy and neglect by friends, family and health services, which had led him to feel threatened by our offers of support. He could seem hostile towards us, and the prospect of accessing medical care seemed remote. Lee’s behaviour could be eccentric and he had little social interaction. His symptoms of psychosis included hallucinations, delusions and thought disorder. As a result he struggled to carry out daily life activities and often presented unkempt, malnourished and with a variety of minor infections.

Over the years we were offering support to Lee, he would often move away or be imprisoned, re-engaging when he felt in acute need, dejected or alone. We were able to demonstrate our genuine care by consistently reaffirming our support for Lee and treating him in a compassionate, caring manner.

In July 2015, Lee presented with the symptoms of chronic cough and haemoptysis (coughing up blood). In early August, we arranged access and supported Lee to go for x-rays and scans. The tests resulted in a diagnosis of small cell carcinoma of the lung. Because of our long and vigilant history with him, we understood that Lee might struggle to engage with the services that would be providing treatment and care.

During the following months, Lee remained predominantly street homeless, and the team took it in turns to attend palliative treatment sessions with him. Beacon House worked in collaboration with the St Helena hospice outreach team, and the local authority housing department, to ensure that Lee didn’t die in the street. His behaviour remained challenging, and he was initially unable to adjust to the constraints of the hospice or housing offers being made. However, the trust we had built over the years of day centre support at Beacon House enabled us to continue supporting him through these transition stages, as well as advocating on his behalf to health and housing providers.

The wider team, which included the St Helena hospice outreach nurse, worked to support Lee and did our best to improve his health. We succeeded in establishing effective multi-agency working with volunteers and staff at the hospice in order to secure a bed, where Lee was able to be looked after and have his emotional and spiritual needs met until his death in December 2015.

All agencies worked together to support a man who had long given up trying to work within systems, but we all adjusted and added to our ways of working to ensure that he had a peaceful and supported environment, as he died. We treated him as a person, not as a list of issues.

At Lee’s funeral, a long-estranged brother was emotionally moved, when he realised how many local teams had gone beyond their standard procedures to ensure he had a good end of life. The stories told spoke of Lee’s challenging determination to be treated as an individual, of his humour and of his humanity.

*To protect their identity, the name of the client in this story has been changed.

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Vivienne Wiggins

Vivienne Wiggins

Chief Executive Officer at Beacon House

Beacon House has provided health and well-being services in Colchester for 20 years. Our aim is to relieve sickness and poverty from people who are homeless or at risk of homelessness. We provide a nurse-led clinic, laundry, food and refreshment, occupational therapy support and access to a range of services.

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