Lancelot, a 38-year-old plumber, became homeless when he lost his job through redundancy and subsequently his marriage fell apart when his wife left him for another relationship. Lancelot had moved to the North East of England to be close to his wife’s ailing mother. He did not and could not have children. He was diagnosed with cancer of the bowel with suspected metastasis. Lancelot started to abuse alcohol and to smoke cigarettes and was neglecting himself. He was sleeping rough under bridges and street corners, begging on the streets and scrounging for food from rubbish bins. He was eventually taken to one of the nearest hostels where he could stay.
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1. On examination, what symptoms are Lancelot likely to present with?
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Correct answer:
Given the fact that Lancelot lost everything that he had in life, he is likely to be very low in mood, unkempt and feeling isolated. Cancer may not be the main problem here. He may not be interested in what is going on around him, and he may not care about his own life that much, and may be drinking excessively. He may complain of pain in his abdomen.
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2. What are the challenges faced by a homeless patient like Lancelot?
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One of the things to consider is that a homeless patient will be feeling lonely even when he/she is in a hostel. The patient may feel as if they do not belong to anything like society and healthcare systems and have got no genuine relationships. The stigma attached to homelessness will be a challenge, and he may not feel he can call the hostel his home.
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3. What palliative care invention would be suitable/appropriate for Lancelot?
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Correct answer:
Given that homeless people are often left out of mainstream healthcare services, this would also be the case with palliative care settings. The most beneficial approach would be to bring in specialists from palliative care services to assess Lancelot for any pain and other distressing symptoms. Tests can be ordered to confirm metastasis and other abnormalities. Psychological intervention should be offered to help Lancelot regain his self-worth and modify his behaviour towards alcohol and smoking and neglecting himself. Long term, there should be effective collaboration between palliative care services and local councils, which includes palliative care education and training for hostel staff.
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4. Does Lancelot still have any rights?
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Correct answer:
Yes, like any other UK citizen, he can register with a GP and use a temporary address. Lancelot can vote in elections, and he is also entitled to claim social services benefits. In addition, he has the right to be given accurate advice by the local council. Lancelot can seek help from charity organisations like a shelter who can offer legal and financial advice.
