So, I’ve been thinking lately. We are pretty darn lucky. Now – this is not intended for me to stand on my soapbox and be all entitled, just as a bit of a reflection and some things to think about.
As a society, we often overlook the reality: the privilege that surrounds the end of life. In first-world countries like Australia we frequently associate death with resources, healthcare, and sometimes even luxury (I’m thinking about private hospital palliative care, for example). On the other side of the coin, there is a forgotten group of people —the homeless and financially disadvantaged—who face challenges to which I could not fathom when being diagnosed and living with end-of-life illnesses.
In 2024, Palliative Care NSW conducted a study that noticed the massive gaps in palliative care accessibility for homeless people across regional, rural, and remote areas of New South Wales. Palliative care, defined as “holistic care for individuals experiencing serious health-related suffering”, is a basic human right, and should be available to all – regardless of social / political / religious / cultural / economic status (you get my point). However, for those without stable housing, a fixed address or the finances, accessing this crucial care becomes a monumental (and sometimes impossible) task.
People who are homeless and require palliative care may commonly lack a site to receive care, as they may move around within shelters or on the street in different locations. This makes the assessment of daily needs difficult. They may also be unable to attend appointments, access the internet, faxes, phone calls (the simple things we take for granted daily) - so accident and emergency departments are often the site of first point homelessness palliative care. Homeless people may often have co-morbidities, including mental health and behavioural problems, and alternative lifestyles which can further complicate their end-of-life needs. There is also the common trend that most homelessness palliative care emergency department presentations are at the end stage of the illness – so when testing is completed, people face the harsh, cruel conversation of a stage 4 weeks to days diagnosis. The worst part? Most commonly, this conversation is had alone with no loved ones or family present, as most facing homelessness are disjoined from their family for a variety of reasons.
Moreover - issues such as lack of social support, medical insurance, and the finances to assist their future care (if any finances, sadly) leave these people teetering on borderline neglect. How heartbreaking as a society, that in 2024 this is happening. Medication storage of strong pain relief that is so desperately needed for those with most cancers and end stage diseases, stealing, and compliance become additional hurdles in their ability to have dignified end-of-life care. The absence of a will further compounds this, hindering the identification of next of kin and delaying vital decisions regarding after-death care (such as funerals, burial or cremation options – even the ability to have a signed death certificate).
Despite these challenges, there is hope in adopting a person-centred approach to care. Ensuring that people feel heard, listened to, and supported by a team can massively improve care and support - reducing the risk of self-discharge from hospital. Volunteers with lived experience of homelessness, such as advocates may play a crucial role in supporting people to cope in what is often a very challenging environment – one that I could not possibly fathom to understand.
In Australia, there exists a massive gap between those who can afford private health palliative care and end-of-life support in the comfort of their homes, and those who cannot. It is easy to forget about those who struggle to make ends meet, like the local man living in a caravan by the river for example. What would happen if he were suddenly diagnosed with a terminal illness? Where would he go? These questions highlight the urgency of addressing the limitations in palliative care and end of life access.
One potential solution highlighted in the study is homelessness shelter-based palliative care. By providing end-of-life care within these settings, terminally ill individuals may be able to receive the support and compassion they deserve. However - implementing these programs requires significant funding and support from governments, charities, and non-profit organizations.
As a compassionate and inclusive society, I hope that we can think about the “elitism” of death, and it is my hope that we can have equitable access to palliative care for everyone. We will all die someday, so it just makes sense. It is also the least that we could do. It is not enough to provide care for the privileged – I hope that we can extend support to the most vulnerable among us. By advocating for policy changes, increasing funding for shelter-based palliative care, and fostering collaboration - we can ensure that no one is left behind in death.
In the end, it is not just about providing medical treatment—it is about affirming life, preserving dignity, and honouring the worth of everyone - regardless of how much they have in their bank account (or even if they have a bank account). The first step is compassion. The second step is to start these conversations.
As I reflect on the differences in palliative care access and the challenges faced by homeless individuals nearing the end of their lives, I am trying to live my life with a little more of this: compassion. In our daily lives (mine too!) - it is easy to take for granted the comforts of my home, the security of a meal on my table, and the assurance of access to healthcare when I need it. But as we enjoy these privileges, perhaps pause for a few moments to consider those who may not share in these.
Compassion calls us to recognize the humanity in every individual, regardless of their circumstances. It urges us to extend a helping hand to those who are marginalized and forgotten, to listen to their stories, and to stand in solidarity with them in their time of need. In the face of adversity and hardship - compassion is what makes us human. It is just the right thing to do.
With love,
Kara x
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