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BMC Public Health. 2012; 12: 312.
Published online May 17, 2012. doi:  10.1186/1471-2458-12-312
PMCID: PMC3355019
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
Ryan McNeil,corresponding author1 Manal Guirguis-Younger,2 Laura B Dilley,3 Tim D Aubry,4 Jeffrey Turnbull,6,5 and Stephen W Hwang7
1British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
2Faculty of Human Sciences, Saint Paul University, Ottawa, ON, Canada
3Faculty of Education, Simon Fraser University, Surrey, BC, Canada
4School of Psychology, University of Ottawa, Ottawa, ON, Canada
5Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
6Ottawa Inner City Health, Ottawa, ON, Canada
7Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
corresponding authorCorresponding author.
Ryan McNeil: rmcneil/at/cfenet.ubc.ca; Manal Guirguis-Younger: myounger/at/ustpaul.ca; Laura B Dilley: ldilley/at/sfu.ca; Tim D Aubry: taubry/at/uottawa.ca; Jeffrey Turnbull: jeturnbull/at/ottawahospital.on.ca; Stephen W Hwang: shwang/at/smh.ca
Received February 9, 2012; Accepted April 30, 2012.
Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
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.
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