Homelessness and palliative care in regional, rural and remote NSW

  • Assortment of personal belongings on a footpath

Homelessness in Rural NSW

A recent study conducted by Palliative Care NSW explored how healthcare professionals provide quality palliative care to people with a life-limiting illness who are experiencing homelessness in regional, rural and remote areas of NSW. The study found that services often adopted unique and flexible models of care to overcome the challenges faced in these settings that were often inextricably linked to environmental, social or financial crises.  

Previous research shows that people experiencing homelessness face higher rates of health issues and premature death than people living in stable and secure housing. In this study, “homelessness” includes people who are living in over-crowded accommodation, cars, garages, caravan parks and couch surfing.  

Palliative care is explicitly recognised as a human right and addresses the physical, psychosocial and spiritual needs of people with a life-limiting illness, to allow them to live their life as fully and as comfortably as possible. People experiencing both a life-limiting illness and homelessness can find it difficult to access quality palliative care, due to the systemic barriers and individual hardships that can result from insecure housing.   

Healthcare workers providing palliative care to patients experiencing homelessness in regional, rural and remote areas of NSW were interviewed. Participants often said the lack of access to resources, staff and services in regional, rural and remote areas can make it “difficult” and “stressful” to provide palliative care to patients experiencing homelessness. Safety was a key issue for palliative care health workers – the safety of themselves, their co-workers, and their patients. From attending “homes” that were structurally unsafe or inadequate for habitation, to securing medications in settings that were overcrowded, and providing care while also managing the “social” challenges of homelessness was difficult. 

A prominent theme that emerged from the study was the determination of healthcare workers to provide quality palliative care as best they could, despite the many obstacles they faced. When asked how they cared for patients in these difficult settings, one simply replied “well, we do what we can”. A willingness to approach each case with flexibility and compassion highlighted the importance of person-centred care particularly for these vulnerable patients. A strong sense of community and social responsibility that is often unique to smaller towns and remote areas meant that healthcare workers often went above and beyond in how they provided care and support. This study also highlighted the benefits of social services and health services working together for this patient population – although there is much more to do. 

In one case where a patient’s needs were not being met, a healthcare worker picked up where other services had not been able to assist, saying that “a lot of people could see the strife the patient was in and did try to help”. Another participant described how workers at their service had voluntarily cared for a homeless patient’s pet dogs, after the patient had declined in health and needed to remain in hospital due to his life-limiting illness.  

As many parts of NSW endure a housing crisis, ageing population and more frequent natural disasters, a person-centred approach to palliative care is more important than ever. High quality palliative care needs to be provided equitably. Flexibility, ingenuity and a highly skilled health workforce will ensure no one misses out. This study also highlighted the importance of social and health services collaborating. Palliative Care NSW acknowledges the skill and local knowledge of the healthcare workers we interviewed for this project, and their unique approaches to supporting some of the most vulnerable members of society. 

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