The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 15: Special Populationsturning point for a person taking control of her or his life. If the person is notin contact with family, it is helpful to ask whether there are friends or otherswho should be contacted if the person becomes ill.26 picasEmotional and Social SupportBiological FamilyHomeless people frequently have been estranged from their families of origin and from spousesand children. However, when they are dying, they may want to re-establish connections withtheir families and attempt to mend fences. Clinicians should always ask whether homeless personswould like to have their family members contacted when it is clear that they are not expectedto get better. Although some health care providers may feel uncomfortable asking or maynot think to ask, resuming contact with family members may be an important aspect of anindividual’s closure. If a palliative care team is in place, any team member who is trusted by thepatient can ask the initial question and bring in others to share responsibility for followingthrough on the patient’s wishes.It is important to remember that reconciliation can be time-consuming. Not only may the homelessperson need support, but family members who are contacted may feel guilt because of theestrangement and may need support as they re-establish relationships with the homeless anddying individual.Shelter Staff as Surrogate FamilyFor many people who are homeless, the staff of shelters and other service agencies becomesupport systems. These may be the most consistent, nonjudgmental people in their lives, andthe ones from whom they want comfort when they are dying. It is therefore important to find outwho should be contacted and included in an individual’s care team. In fact, shelter and otherservice agency staff may need a support group or other bereavement services, either because oftheir involvement in a single individual’s care, or because they are experiencing multiple lossesas numerous clients with HIV become sick and die. The stress and distress of being unable to domore for people who are homeless and dying can take a terrible toll on social service providersin community-based agencies. (see Chapter 20: Care for the Caregiver.)XVOther Homeless PeopleSome people who are homeless have close relationships with other homeless individuals whohave become their families and may become dying person’s caregivers in his or her last days. Forthis reason clinicians should respect and support close personal relationships, while also beingalert to potential abuse, such as a “friend” taking the patient’s pain medications herself or himself.Incarcerated Family and Loved OnesFor homeless people who recently have been released from jail or prison, their closest relationshipsmay be with people who are still incarcerated. This may be an unfortunate result of “compassionaterelease” for the dying. Other homeless people may have close family members whoare in jail or prison. Resolving this isolation is difficult, because the penal system rarely allowsprisoners to visit family members on the outside, much less loved ones who are not related, evenwhen those people are dying.U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 319