'I dream of the airplane, but I cannot board it': Exploring end-of-life aspirations with people who have lived experiences of homelessness.

BACKGROUND

Little is known about how people experiencing homelessness discuss their end-of-life aspirations or the extent to which these align with current models of Advance Care Planning.

OBJECTIVES

To explore how people with lived experience of homelessness discuss their end-of-life aspirations and identify implications for Advance Care Planning.

DESIGN

A qualitative study was undertaken underpinned by a social constructionist framework.

METHODS

In-depth interviews were conducted with 16 participants with lived experiences of homelessness living in a major city in Aotearoa New Zealand.

RESULTS

Participants had difficulty in formulating aspirations and these were magnified when considering end-of life due to the challenges of predicting future resources, including shelter, food, and sources of social support and connection. End-of-life aspirations discussed involved basic needs being met, for example, through warm and dry shelter, access to a safe, non-chaotic space, and having access to food and showers. A good relationship with a trusted supporter was identified as an important enabler of end-of-life aspirations being realised. However, participants were unable to identify who would support them at end-of-life. Experiences of healthcare shared indicated that people were not provided with appropriate information, and the relational characteristcs were not present, to enable them to make decisions about their care and treatment.

CONCLUSION

Mainstream approaches to Advance Care Planning do not meet the needs of people with lived experience of Homelessness. New professional approaches are needed that are responsive to experiential knowledge and context, connect different care networks, and recognise the injustices linked to structural disadvantage. Approaches must be developed in partnership with people with lived experience of homelessness. Supporting aspirations for living is a necessary first step to consider aspirations when dying for people experiencing structural disadvantage and discrimination.