Walking through Stephen’s journey and his interactions with Angela can help explain how a palliative approach to care could be applied throughout their relationship.

Meet Stephen and Angela

Age: 44 year old Indigenous male
Housing Status: Experiences with homelessness and
unstable housing. Lives in transitional housing and visits
various drop-in centres.
Family Background: Has not had any contact with his
only brother over the last few years. Identifies as
Health: Lifelong smoker, suffers from alcohol addiction.
Suspected to suffer from liver disease.

Stephen has been living in transitional housing for the last 3 months, where he is supported by Angela, a social care worker at the building. 

Age: 31 years old
Occupation: Social Care Worker
Goals: Studying for her Bachelors of Social Work Degree

“Sometimes I am the only one who they will talk to and I don’t want to let them down.”

Angela is a social care worker employed by a local supportive housing organization in a Canadian city. She has been a worker for 5 years in a variety of settings including; emergency shelters, a drop-in centre, and on the streets. Angela often works with men who struggle with drug and alcohol addiction, but she also comes into contact with a diverse range of people. This includes individuals experiencing homelessness who live with chronic illness and many near their end-of-life.

People often say to Angela that her line of work must be so rewarding, and while she agrees, she also knows the daily challenges.

Angela has learned to be prepared for absolutely anything and sometimes experiences unsafe situations. It is exhausting work and frustrating, but Angela also knows that she is often the only person her clients can rely on and trust. They are some of the most vulnerable people, often living among circumstances beyond their control and within a system that has let them down many times. She doesn’t want to be another person
who has let them down.

Angela completed a Social Service Worker diploma program and has been studying part-time for a degree in social work.

Angela wants to do all she can to become a better and more informed advocate for her clients, though she truly believes that nothing is a better teacher than her
daily work experiences. She knows the more education she has, the better she will be able to navigate through a complex and frustrating

A palliative approach to care recognizes a person’s unique life situation, including their homelessness.

Follow their journey below

Stephen hits his head

Stephen visits a drop-in centre where he falls and hits his head. Staff at the centre call 911. 

Stephen was under the influence of alcohol at the time of his fall. 

 At the Emergency Department, the doctor notes Stephen has low blood pressure and shortness of breath.

One of the greatest challenges workers have is effectively communicating with health care providers to improve access to health care for the people they work with. Building rapport and communicating effectively with health care providers can be an important aid in working positively together. Just as it is important to build relationships between workers and the people they support, relationship building is important between workers and health care providers.

Building rapport with health care providers
Communication strategies
Glossary of Basic Terms and Acronyms Used by Health Care Professionals

Stephen experiences pain

Over the next month Stephen complains of on-and- off abdominal pain. 

He tries to manage his own pain by taking different substances and drinking heavily. 

Angela notices that he is having bouts of extreme confusion and disorientation, even more than what he usually experiences from his drinking.

It is important for workers to know some basic information about the person they are caring for that might impact their health and access to health care services. 

Obtaining Basic Health Information
Common Diseases

Stephen collapses and is brought to the hospital

One day, Stephen is in so much pain that he collapses. An ambulance is called and Angela goes with Stephen to the hospital. 

When at the hospital, the doctor on-call sees Stephen has delirium and an enlarged abdomen. 

Angela speaks with the doctor and explains that Stephen has been complaining of these symptoms for months. He is subsequently admitted to the hospital for further observation and testing.

When working within a palliative approach to care – or a harm reduction approach – it is important to have an understanding of the person’s health and social needs. It is also important to know how much a person actually understands about their own health situation. Both of these will help in recognizing the person’s experience, and in providing guidance and information about what additional supports could be available.

Person and Worker’s understanding of the person’s health condition and status
Understanding the unique health care needs of the individual
Education of health care providers about a person’s unique needs

Stephen receives a diagnosis

After further consults with a specialist, Stephen is diagnosed with late stage liver disease. 

He is told there is too much damage to be eligible for a transplant. Despite this, it is recommended that he stops drinking and smoking immediately.

He is given instructions to come back for follow up with the specialist in 2 months.

Workers need to know the palliative care options that are available in their local community in order to support access for people who are homeless with life-limiting or chronic diseases. These options can be found by searching on-line or by connecting with people in their community.

Palliative Care Options and services available
Financial Resources and Benefits for Individuals who are Homeless

Stephen has to cope with the news

Following his discharge, Stephen is back in transitional housing with Angela. 

She knows the information Stephen received in the hospital must be hard for him to process. Angela isn’t sure how to talk to Stephen about this news.

Having conversations about end-of-life issues can be an important part of ensuring people experiencing homelessness are informed about their care options and have their needs met. These conversations can be difficult and intimidating to start and outside a person’s comfort zone.

How to Begin End-of-Life Conversations
Identifying the person’s support networks
Knowledge of Legal Rights for Individuals

Stephen's health is declining and Angela begins to grieve

Stephen has not been doing well in the last few weeks. He is not sleeping and has no appetite. Nausea has become common for Stephen, but now he has started to vomit blood. 

Angela calls 911 and Stephen is brought to the hospital. Angela can’t go with him this time.

Stephen is admitted to the hospital. He is suffering from extreme delirium and continued nausea. The doctor at the hospital gives Stephen medication to help with his pain. Overnight, Stephen dies.

Angela is notified of Stephen’s death by the hospital. They ask Angela if she is aware of any next of kin that can be contacted. 

She wants to plan a small memorial service for Stephen to ensure he does not go without being remembered.

Each person experiences grief differently, moving from deep sadness to healing and recovery, and will take different approaches to dealing with their grief. It is important to recognize that the people who support people who are dying also experience grief, especially if they experience frequent deaths of clients, some of which might be very traumatic.

Grief and Bereavement

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