Is moral adequacy possible in the face of structural disadvantage? The experiences of health and social care staff in supporting homeless people using substances at the end of life.

Background: Homeless people using substances at the end-of-life face many challenges in accessing and receiving good care. These can relate to poor interdisciplinary working by health and social care practitioners, stigma and structural disadvantage. Objective: Using positioning theory, we explored the challenges of existing models of practice for practitioners supporting this population. Research design: This is a qualitative descriptive study in which data were collected via four interdisciplinary practitioner focus groups. Data sources and methods: The four online interdisciplinary focus groups were conducted within a region of North-West England. This included 24 participants from health and social care providers with experience of working with and/or supporting people experiencing homelessness and using substances. Results: The findings indicated three primary discourse positions related to (i) What constitutes a good death and where? (ii) The limitations of professional boundaries and (iii) Maintaining moral adequacy in the face of traumatic death. For practitioners, maintaining moral adequacy was often compromised by ineffective multi-disciplinary collaboration. Practitioners were often exposed to traumatic working experiences with limited resources to effect change. Conclusion: The findings support work examining the structural and environmental challenges of palliative care provision for hostel-users and unsheltered homeless people in providing care at the end of life for people experiencing homelessness.