21 Legacy planning for people experiencing homelessness

<h3>Background</h3> People living with homelessness experience a high burden of chronic, often untreated physical and mental health conditions. Furthermore, the diagnosis of a life-limiting illness is typically made late in the disease trajectory, if at all. As a result, their life expectancy is 20–30 years shorter than the housed population. Challenges often associated with being homeless, including mental health, addiction, trauma and mistrust, can impact the nature of dying for this population. Death may appear sudden but is not entirely unexpected given the health risks associated with being homeless. Our previous research identified that many people who are homeless have few choices and do not perceive healthcare environments as safe spaces or have trust that the healthcare system will support their autonomy. Estrangement from whānau and family can mean they have few options identifying someone who they can trust to speak for them when they cannot speak for themselves. Therefore, Advance Care Planning in its traditional from may be largely inaccessible for people experiencing homelessness. <h3>Aim</h3> This presentation will present findings from phase 1 of a 3 phased study which aims to develop an adapted advance care plan for people experiencing homelessness. <h3>Methods</h3> A qualitative study design using an arts-based methodology was used to explore legacy and end-of-life planning with the homeless community. <h3>Results</h3> Using questions such as: 1) How do you want to be remembered? 2) What has been most important to you in your life; and 3) What advice would you pass on to those who come after you; provided unique insight into the end-of-life preferences and needs of people experiencing homelessness. We will discuss how these insights can be used to develop a modified ACP framework which can be utilised outside the mainstream healthcare system for people experiencing homelessness. <h3>Unique Contribution</h3> Traditional advance care planning for people who are experiencing homelessness is challenging. A focus on legacy rather than preferences for healthcare at the end of life, may make advance care planning more accessible for the homeless population. <h3>Implications</h3> An ACP framework that is informed by the views of the homeless community will increase opportunities for engagement and improve outcomes for people at the end of life. Giving the homeless community a voice through the use of arts-based methodology and co-design of the ACP framework will be empowering and transformative for participants.