Domain	Recommendations
Alcohol-related harm	• Provide staff training on harm reduction, social determinants of health, and trauma-informed care principles. • Use individual- and community-level harm-reduction approaches to address residents’ alcohol-related harm. • Ensure approaches to addressing alcohol-related harm are environmentally and culturally appropriate for residents in the particular HF community.
Perceived health vulnerability	• Provide training to staff and other providers who work in close proximity to the HF community on medical and psychological sequelae common among people with co-occurring alcohol use disorder and homelessness (e.g., traumatic brain injury, cognitive deficits due to heavy alcohol use, earlier onset of geriatric conditions, posttraumatic stress disorder). • Orient residents upon move-in to the available health services and steps to access them. • Deliver women’s groups to offer a safe space for women to obtain support. • Ensure adequate accommodations are made for residents with disabilities, both in terms of the built environment and in the health services provided.
Concern for fellow residents	• Upon move-in, prepare HF residents for the scope of health difficulties among fellow residents and its potential impact. • Schedule community meetings and invite residents to share with staff and one another what they need to ensure the community is effectively supported. • Support residents’ in establishing their own support groups, depending on the unique needs of the HF community.
End of life	• Provide support for staff on palliative approaches to service delivery. • Ensure external healthcare providers who deliver onsite end-of-life care are educated on issues unique to dying among individuals with a history of homelessness. • Ascertain and document resident preferences for end-of-life care. • Employ a harm reduction approach to substance use in end-of-life care. • Enable dying in place, if preferred by resident, when possible. • Respect cultural beliefs and end-of-life practices. • Support housewide memorials and services for residents who have died. • Integrate grief counselling services into HF, ideally with individual and group milieu options; make services available to both residents and staff.
Health and safety promotion	• Co-locate physical and mental health services on-site. • Establish links with external services to manage complex conditions and provide specialized (e.g., dental care) or intensive (e.g., skilled nursing facility) care. • Strive for care continuity across healthcare providers and auxiliary supports (e.g., carers). • Conduct resident wellness checks. • Design private and communal spaces that are safe and accessible (e.g., install grab bars, design wheelchair-friendly kitchen and bathroom spaces). • Remind staff and residents about safety measures (e.g. post fl yers). • Conduct further research into the lived experiences of residents in single-site and scattered-site HF to establish best practices approaches to healthcare provision, including end-of-life care, across diff erent HF models.

Note:

HF = Housing First

These recommendations were based on responses from residents in single-site HF and may or may not be relevant for other HF configurations (i.e., scattered-site). For information to guide policy development related to end-of-life planning for people experiencing homelessness more generally, visit the National Health Care for the Homeless Council website: https://nhchc.org/clinical-practice/diseases-and-conditions/end-of-life-care/