Health care providers should directly address issues surrounding death and dying with homeless patients

Health care providers should directly address issues surrounding death and dying with homeless patients, according to researchers from the University of Minnesota's Center for Bioethics.

To study homeless persons' attitudes and experiences with death and end-of-life care, the researchers conducted focus groups through Twin Cities service providers who work with homeless persons. The results of these focus groups are summarized in two papers that appears in the April issue of the Journal of General Internal Medicine; the article is currently available online.

Lead researcher John Song, M.D., said the people who participated were very concerned with the type of care they would receive when they are dying and after they die. While many of the concerns were similar to that of housed people, he found homeless people had several concerns specific to their living situation.

The study participants had concerns about dying in a place where no one would find them and dying in anonymity, with no memorialization.

Some study participants expressed fear about not being cared for compassionately or adequately by health care providers because of their homelessness. Many did not want their families notified of their deaths because they were ashamed of their homelessness or didn't want to be burdens, while others wanted to make sure their families knew if they were dying. Finally, many homeless persons advocated for increased advance care planning for people living without a home.

"There is a strong need for documenting the wishes and concerns of homeless people in terms of what medical treatment they want," Song said. "It's important to remember that these people are individuals who came to live on the streets for different reasons, and we can't make assumptions about their feelings on death and end-of-life care."

He added that many health care providers tend to focus on the immediate needs a homeless person has, but addressing end-of-life care should be a priority as well.

Song's research was funded by the National Institute of Nursing Research, the lead group within the National Institutes of Health on end-of-life research.

"This is one of the very few research studies to focus on the end-of-life experiences and perspectives of homeless persons," said NINR Director Dr. Patricia A. Grady. "The research programs supported by NINR place a strong emphasis not only on end-of-life, but also on those who are underserved in our health care system. Dr. Song's innovative study helps put NINR at the forefront of this area of concern for the health of our nation."