The shift in focus created by Covid-19

Alison, a palliative care nurse working with the homeless in Cheshire, recounts her experience of providing care during the pandemic

29 June 2020


My name is Alison a Nurse based at St. Luke’s (Cheshire) Hospice.  My role involves working with local homeless people and organisations to bring about choice and care for some very vulnerable and unwell individuals thought to be in the last 12 months of life. Many of those I come into contact with will have challenging social issues as well as living with drug and alcohol dependency (substance misuse).

Shifting shape to fit the new reality

I’m comfortable in my role and love it. It’s taken me several years to build relationships with local homeless organisations and their customers. As a hospice we have now supported a number of these customers/patients to a better life and a good death. But the world we all know has changed. How can I remain relevant when this pandemic has changed both the way we live and die? I have shifted my thinking from ‘how can we support and facilitate a good death’ to ‘how can we support the hostels to ensure people survive this virus’.  In supporting the hostels to plan, obtain protective equipment and offer support emotionally, I can ensure I am available for the living and the dying.

Adapting to a different role

I have been asked by hostels and homeless organisations if they need PPE? If so, how can they obtain PPE? How can they get tests for their staff to get them back to work? Can they set up a ‘sick bay’ in the accommodation for those who may have the virus? What if someone gets it and is sharing kitchen/bathroom facilities? There has been much guidance, but most concentrated inevitably around London. However, with London based help coming through Microsoft team meetings, our own local infection control and many emails and discussions with the local CCG, LA and others has eventually brought about the answers. The picture is continually changing and the questions then change again.

Ensuring support for the dying

The dying are very much with us – be it from this terrible virus or COPD, liver failure, cancer, etc. At the outset of the virus it felt like all other sorts of deaths were to be suspended – almost that palliative care for ‘normal’ deaths had become a bit of a luxury!

Advance care planning remains imperative. However, it’s been impossible to meet with clients face to face since the lockdown. [We are] shifting and changing to keep any support highly relevant.

Advance care planning remains imperative. However, it’s been impossible to meet with clients face to face since the lockdown. I have had difficult discussions with one individual in particular and this has had to be by mobile – limited yet necessary. Homelessness workers are working in more emotionally difficult situations. Locally we have had fantastic support from the hospice counselling teams who have made themselves available for staff during this Covid outbreak. We are also looking at accessing some technology to make ‘face to face’ access (albeit virtually) a possibility. Shifting and changing to keep any support highly relevant.


The changing landscape looks and feels different, but actually some things remain unchanged. Homeless people with a life limiting illness still need help to talk, plan and access great palliative care. Hospices still have an important role in being part of this and working across all sectors to enable this to happen.

Find out more about our year of celebrating palliative nursing and our webinar series on Rising to the Challenge in Nursing.

29 June 2020

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