Harm reduction services as a point-of-entry to and source of end-of-life care and support for homeless and marginally housed persons who use alcohol and/or illicit drugs: a qualitative analysis

• Published in: BMC public health Vol. 12; no. 1; p. 312
• Main Authors: McNeil, Ryan, Guirguis-Younger, Manal, Dilley, Laura B, Aubry, Tim D, Turnbull, Jeffrey, Hwang, Stephen W
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 17.05.2012; BioMed Central; BMC
• Subjects: Acquired immune deficiency syndrome; AIDS; Alcohol Drinking - epidemiology; Alcohol Drinking - prevention & control; Alcohol use; Analysis; Attitude of Health Personnel; Canada; Case studies; Drug use; Female; Harm Reduction; Health aspects; Health Services Accessibility - statistics & numerical data; HIV; Homeless persons; Homeless Persons - statistics & numerical data; Hospitals; Human immunodeficiency virus; Humans; Illegal drugs; Interviews as Topic; Male; Methods; Mortality; Palliative treatment; Professional-Patient Relations; Program Evaluation; Research Design; Residence Characteristics; Risk Management; Settlements & damages; Severity of Illness Index; Social service; Social Support; Street Drugs; Substance Abuse, Intravenous - epidemiology; Substance Abuse, Intravenous - prevention & control; Substance-Related Disorders - epidemiology; Substance-Related Disorders - prevention & control; Terminal care; Terminal Care - utilization; Canada
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/1471-2458-12-312

Homeless and marginally housed persons who use alcohol and/or illicit drugs often have end-of-life care needs that go unmet due to barriers that they face to accessing end-of-life care services. Many homeless and marginally housed persons who use these substances must therefore rely upon alternate sources of end-of-life care and support. This article explores the role of harm reduction services in end-of-life care services delivery to homeless and marginally housed persons who use alcohol and/or illicit drugs. A qualitative case study design was used to explore end-of-life care services delivery to homeless and marginally housed persons in six Canadian cities. A key objective was to explore the role of harm reduction services. 54 health and social services professionals participated in semi-structured qualitative interviews. All participants reported that they provided care and support to this population at end-of-life. Harm reduction services (e.g., syringe exchange programs, managed alcohol programs, etc.) were identified as a critical point-of-entry to and source of end-of-life care and support for homeless and marginally housed persons who use alcohol and/or illicit drugs. Where possible, harm reduction services facilitated referrals to end-of-life care services for this population. Harm reduction services also provided end-of-life care and support when members of this population were unable or unwilling to access end-of-life care services, thereby improving quality-of-life and increasing self-determination regarding place-of-death. While partnerships between harm reduction programs and end-of-life care services are identified as one way to improve access, it is noted that more comprehensive harm reduction services might be needed in end-of-life care settings if they are to engage this underserved population.