Centering Humanizing, Individualized Care Amid Systemic Barriers: A Qualitative Exploration of Provider Approaches to Palliative and End-of-Life Care for Unhoused Adults

Abstract

Palliative and end-of-life (PEOL) care offers many benefits to those with life-limiting illness; however, people experiencing homelessness face systemic and social barriers to accessing such care. Healthcare (HC) and social service (SS) providers who work with unhoused individuals have essential roles and insight for how PEOL needs are addressed among this population which may inform opportunities to improve care. This study, therefore, explores Colorado-based HC and SS providers’ approaches working with unhoused individuals with PEOL needs. An exploratory–descriptive qualitative approach was used to conduct semistructured interviews with HC and SS providers in Colorado who provided direct care or services to adults. An iterative thematic analysis approach was used to code and analyze interviews. Seventeen providers were interviewed between June and September 2022, representing settings including hospitalist specialty services, hospice, housing/homeless services, aging services, and community mental health. Amid systemic challenges, including lack of resources and pervasive stigma toward unhoused individuals, providers highlighted person-centered and holistic approaches to care that prioritize building trust and honoring dignity and autonomy. Providers emphasized the importance of organizational commitment to these humanizing approaches while transforming culture surrounding poverty and end-of-life. Further, interviews identified potential solutions to improve PEOL care for individuals experiencing homelessness, including specialized interventions (e.g., mobile palliative care). These findings highlight realistic, humanizing approaches to care providers can incorporate into everyday practice and support the need for specialized PEOL services, policy reform in housing and HC (better housing solutions, hospice reimbursement, etc.), and efforts to address and disrupt homelessness stigma.