Past work 2015-2025
People experiencing homelessness encounter significant barriers in accessing health care services, experience poor health outcomes and frequently die young. ‘Homelessness’ includes people sleeping on the streets (rough sleeping) and in insecure or temporary accommodation, including hostels, squatting and sofa surfing.
For many people, homelessness is associated with deep social exclusion such as having been in an institutional setting while a child, substance misuse, severe mental illness or involvement with the criminal justice system. This is often referred to as multiple-exclusion homelessness (MEH). The majority of people with MEH have experienced significant trauma, often starting in childhood.
Dr Caroline Shulman and Dr Briony Hudson have led several research projects aimed at understanding and meeting the palliative care needs of people experiencing homelessness.
This work includes:
- A systematic review of palliative care and homelessness
- A large qualitative study exploring barriers in providing palliative care and challenges to discussing palliative care with people who are homeless
- Development and evaluation of training for hostel staff
- Creation of an online training resource for frontline homelessness staff
- A project linking community palliative care teams with homeless hostels in the form of regular inreach resulting in improved identification of people with concern, more support brought into the hostel from the multidisciplinary support and more referrals into the local hospice.
- Exploration of frailty and holistic needs within a homeless hostel. Working with a geriatrician the team demonstrated that many people with a history of rough sleeping within a hostel setting, are frail and experience high rates of multimorbidity at a much younger age than the general population
- Development of a questionnaire that frontline homelessness staff can complete with their clients, to explore unmet health and care needs.
- Development of a short film outlining some of the challenges experienced by people who are homeless with advanced ill health, and recommendations for improving access to care for this
- Development of the TIFFIN recommendations for involving people with lived experience of homelessness in palliative and end of life care research
- Creation of the National Palliative Care and Homelessness Network which has bought together people across the UK who have an interest or are working in this area
- Development and evaluation of the Intervention to Optimise Palliative Care for People with Lived Experience of Homelessness (IMPROVE)
For more information on any of this work please contact: