Issues for people experiencing homelessness
The difficulty of knowing how many people experience homelessness in Australia is due, in part, to the problem of how to define homelessness.
It was estimated that on census night 2001, there were 100,000 homeless people in Australia. This figure included those without conventional accommodation as well as those in boarding houses, in emergency or transitional accommodation, those staying with friends, and those sleeping rough. Around 14,000 of these were counted in the ‘rough sleepers’ category. Young Australians make up the largest proportion with 46% aged under 25 years. However, nearly one quarter are aged over 45 years, with a significant percentage having multiple or complex needs. [1]
On an annual basis, the main government funded response to homelessness (Supported Accommodation and Assistance Program) provides assistance and support to over 160,000 Australians through 1,300 funded services. [2]
Further information is available on the Homelessness Australia website.
Common issues
There are issues common to people who are homeless and require palliative care. The first is that they lack an adequate site to receive care, as they can move around within shelters or on the street. This makes the assessment of daily needs difficult. They are also often unable to attend or travel for appointments.
When receiving treatment issues such as lack of storage facilities for medications and problems with theft of medications need to be considered. Patients may be tempted to barter medications for food or other needs. Compliance can be low, and literacy can contribute to this.
Co-morbidities often exist, including mental health and behavioural problems. Alternative lifestyles such as illicit drug use, alcoholism or prostitution will also impact. With little social support, no medical insurance, and little financial capacity, healthcare will not always take priority over other needs. Accident and emergency departments are often the site of care.
This group of people is highly vulnerable. Most approaches look at partnership models between health and community services, such as housing and justice health. Specialist palliative care services need to identify and work alongside local homeless services (Supported Accommodation and Assistance Program), and local health and nursing services such as District nurses.
Wills and funerals
Many people experiencing homelessness will not have made a will. If they do have a will it could be one that was prepared years ago and is perhaps lost. Having a will can help in many ways. It is important for locating next of kin, and in decisions regarding after death care.
Identifying next of kin is important for many reasons. Not having someone to contact could delay a transfer to a hospice when the person has no money, and there are no financial arrangements in place regarding the funeral. It is important that a contact person is identified even if the patient doesn’t want them involved until after death. Some can be afraid of information sharing with their next of kin or contact person. It is important if this is the case, to highlight that confidentiality will be maintained and the patient is always is able to say when their next of kin is contacted. After death, the next of kin may not want the responsibility of the funeral, but the social worker will then know to take on this responsibility.
CareSearch has a page on wills and funerals.
Community health services
- Social workers can be contacted at local community health centres. State Resources pages can help locate community health services.
- The Council to Homeless Person’s website has a summary of some of the issues faced by those who are homeless. This is written by staff at the RDNS (Melbourne) Homeless Persons Program.
- Many nursing services will work alongside services for the homeless to help people who may need care. The Royal District Nursing Society in Victoria has information on their website that gives examples of how they help.
Resources
References
- Australian Bureau of Statistics. Australian Census Analytic Program: Counting the homelessness, 2001. 2003; ABS cat. no. 2050.0.
- Australian Institute of Health and Welfare. Homeless people in SAAP. SAAP National Data Collection annual report 2005-06, Australia. 2007; AIHW cat. no. HOU 185.
This page was created on 8 September
Last updated 9 June 2011*