Review: Terminally-ill homeless adults face significant barriers in accessing palliative care

Terminally-ill homeless adults and their care providers must surmount many obstacles in the receipt and provision of palliative care, according to a University of Toronto scoping review of the available grey and peer-reviewed literature on this topic, published online this week in OMEGA - Journal of Death and Dying.

"Homeless individuals often live and die in the margins, disengaged from or avoidant of a health care system that they perceive as unwelcoming or discriminatory. Their care may also be medically complex and they are more likely to have comorbid physical and mental health problems, all of which may pose particular diagnostic and prognostic challenges for providers," said lead author Keri West, a PhD student at the Factor-Inwentash Faculty of Social Work.

"Some of the most consistently reported barriers to palliative care relate to pervasive stigmatizing beliefs about homeless people that may impede the provision of compassionate, supportive care at the end of life," reports Alex Coatsworth, study co-author and Social Worker at Baycrest Health Sciences. "There are many other challenges with traditional models of palliative care for the homeless population, including practical and logistical issues, such as needing power to refrigerate medications."

Although the review identifies extensive unmet needs, it also points to opportunities to improve quality of life at end-of-life for people who are homeless.

"We found a number of promising, inclusive models, such as those that are oriented toward a harm reduction philosophy, that have the potential to enhance dignity and autonomy at the end of life while also supporting care providers. Shelter and hospice staff often function as family for homeless persons. This may involve a significant emotional investment so it is important to ensure that caregivers are also cared for," said Brittany Wrobel, study co-author and Enterprise Customer Support Advocate at Softchoice. "Specialized training for providers is key to addressing the needs of this very vulnerable population."

"This is a burgeoning literature, which is very encouraging," said Stefania Pallotta, study co-author and Psychogeriatric Case Manager at LOFT Community Services. "We located 57 articles that focused on the palliative needs of homeless adults, and of these, 36 had been published in the past decade. It shows that there is a growing interest in better serving this vulnerable population."