35 Developing and evaluating collaborative planning of future care – advance care planning in a long-term residential setting for older homeless adults. A qualitative study

IntroductionThe older homeless adult has complexities and needs that differ to either their younger counter parts or those of equivalent age in the general population. In the absence of family and decision makers they are at greater risk of dying without having their wishes documented or at least discussed. There is an urgent need to find appropriate and effective ways in improving advance care planning provision for this cohort.AimsExplore the views and experiences of older homeless adults and frontline staff regarding Advanced care planning Suggestions for improving service provision.MethodCo-operative inquiry action research design was applied. Face-to-face semi-structured interviews using a purposive sample were completed with residents and staff (N=13). Thematic analysis was conducted.ResultsThemes generated; (1) lived experience concerning the meaning of advance care documents and their experience thus far. (2) The importance and meaning assigned to funerals and care of remains after death. (3) Communication which included influencing factors of; the how and the when conversations should occur and the need for honesty within those conversations. Theme four explored the area of gaps in the existing system including influencing factors of; identifying educational and learning needs and improving the ACP documentation process.ConclusionThe results of this study highlight a number of areas that need to be addressed; the urgency of designing and implementing a fit for purpose document that appropriately addresses the needs of the residents; the need for further investigation on the when and how conversations should occur; that these conversations require honesty and realism and finally the need for staff training.