Ms Joan Ryan1,2
1Royal Prince Alfred Hospital, Sydney, Australia, 2Palliative Care New South Wales, Sydney, Australia
Biography:
Joan Ryan is a Palliative Care Nurse Consultant at Royal Prince Alfred Hospital, Sydney. She has vast clinical experience in Palliative Care Specialist Nursing with a strong commitment to improving access to Palliative Care in poorly resourced nations and within vulnerable populations both nationally and globally. She supports a public health approach to re shaping many existing models of care in recognition of the need to serve a broadening diversity of cultural and social minorities within changing world of climate change a place to call home.
Abstract:
Background: People who are homeless have a reduced lifespan compared with the general population but inequitable access to palliative care. Many current mainstream health services lack awareness and flexibility to support equitable access to palliative care for those experiencing homelessness. This presentation will compare point of entry into palliative care for two people experiencing homelessness leading to and the often late, chaotic and unfortunately nearing end of life.
Aims: To increase awareness of the unmet palliative care needs of people experiencing tertiary homelessness in Sydney local health district that results in at least two direct referrals from community services between July-December 2022 from a baseline of zero.
Method: Two case studies informed the basis for following the Stanford Centre quality improvement process, a SPHERE PC-CAG project gap analysis included mapping current referral pathways, a “fish bone” analysis, and a local area map of socio-economic disadvantage. Identified key drivers, included recognition of the complex needs of homelessness populations and focused relationships with key stakeholders. Targeted interventions included staff and key stakeholder education, site visits, homelessness services and a centralized point of contact for palliative care referrals.
Findings: We surpassed our initial goal of two direct referrals for people experiencing homelessness with palliative care needs, achieving 10 referrals by December 2022.
Conclusions: Shifting referral pathways from within acute hospitals to community homelessness services who already have established relationships and knowledge of the unmet health needs of people encouraged earlier access to palliative care services. Driving change and addressing unmet palliative care needs of people experiencing homelessness can be achieved through structured quality improvement approaches, creative partnerships, building on trust and connection with the homelessness services already supporting the homeless This project further led to a second phase Quality Improvement collaborative titled Mary Aikinhead, Partnership with Purpose (2024) and Inaugural Palliative Care and Homelessness Forum.