"Caring for Diana was challenging, but the right thing to do"

Alison Colclough, Homelessness Service Lead at St. Luke’s Hospice in Chester, writes about the nearby Hospice of The Good Shepherd and how it enabled Diana to improve the quality and length of her life. 

When Diana was referred to the Hospice of The Good Shepherd (HGS) in Chester, she was in her 60s and had been supported by homelessness services for over 25 years. At the time of her referral by a dedicated homelessness GP practice, she was living in supported accommodation. 

Diana had complex health needs. She was hugely underweight and prone to infections involving multiple internal organs. She was also on a methadone prescription and had been for a number of years. As healthcare professionals, we would not have been surprised if she were to die in the next 12 months. 

She came to the hospice from the hospital for symptom management. However, it soon became apparent that she did not wish to return to her supported accommodation, and she cited safeguarding as an issue.

Good care despite the challenges

As a small hospice with 10 beds serving a population of 350,000 people, it was important that Diana got the care she required, while at the same time acknowledging pressure on hospice beds, not just for symptom management but also end of life care.

During her first few days on the hospice ward it became apparent she had symptoms that needed addressing, including her unsafe mobility following a fall. She also needed somewhere safe to go upon discharge. At this early stage Diana was struggling physically and asking for a place in a residential care home.

The ward staff worked on symptom management, with the hospice social worker and the homelessness worker jointly working to find suitable accommodation as a priority. It took over two weeks for a social care assessor to be allocated, even though Diana’s case was urgent. Social services are consistently under resourced and under staffed, which has an obvious impact on those seeking support.

Partnering with local services

A meeting was called at the hospice. The local authority social worker felt that it would be extraordinarily difficult to place Diana in a residential home as she smoked and was told none of the care homes would allow it. Diana said she could not give up smoking, and therefore would prefer her own flat with support.

A housing officer was contacted, who was incredibly proactive in gathering information around Diana, and completing a housing application form.  

After several weeks she was offered an appropriate bungalow. The hospice warehouse provided some furniture, as did the local authority, and staff from the ward also generously supported Diana to furnish her property.

An “incredible change in health”

During these weeks Diana got stronger and gained weight. Her medication was significantly reduced, and by the time she was able to move in to her bungalow she looked well, felt well and was safely mobile.

Diana had been in the hospice for over 10 weeks at the time of discharge. During this time the change in her health was incredible. Being ‘stuck’ in the hospice was in the end a very good thing for her - she was not only living, but was living well and would probably live for longer.

Providing the care each person deserves

The hospice had a reflection session after Diana’s discharge. There were several issues raised. Firstly, the fact that she had remained on the ward for 10 weeks. The average stay is two weeks which meant there were potentially four other people in need during that time who were unable to access a bed. 

However we discussed that sometimes the hospice does get individuals who inadvertently stay longer than planned. Every case is taken on its merit and it was felt that the next homeless person to be referred to the ward would also be considered in this way, and this prolonged stay would not affect someone’s chances in the future.

COVID-19 had also made the stay more difficult. Patients would normally be able to wander around the ward, talk to other patients and make themselves a drink. Diana was unable to do this, adding extra work for staff and making the experience more isolating for her. 

She also needed to get to the post office occasionally for money, and this meant further isolation on return. This was difficult for her and for staff, who accepted that she had no friends or family available to help. 

Care for everyone who needs it

When Diana was first referred to the hospice it was believed she had less than a year to live. However, with great care, good nutrition and regular medications it was obvious on discharge that she may easily have much more time than this. We recognised that we had to shift our thinking and celebrate that we had not only added to Diana’s quality of life, but also to its quantity. 

When working with people experiencing homelessness there are inevitably complex issues, both socially and medically to deal with. Palliative people experiencing homelessness have high needs but access to palliative care is often limited. 

Although caring for Diana was both complicated and challenging, it was the right thing to do. The hospice will strive to continue to be fair, and open to everyone who need its services, regardless of who they are, or their background.