Providing End-of-Life Palliative Care for the Homeless


Providing End-of-Life Palliative Care for the Homeless - Healthify

A significant gap in the health care system for one of the most vulnerable patient populations may be slowly closing. Thanks to innovative new programs, increased numbers of homeless men and women fighting fatal illnesses and chronic conditions are receiving the palliative and respite care they so desperately need. 

With many seriously ill homeless patients seeking care only when in dire need, these vital programs work to improve quality of life, preserve the dignity of the patients, and help to better utilize health care resources.

A leading pilot program started on the streets of Seattle, Washington in 2014. The program, run jointly by the University of Washington’s School of Public Health and UW Medicine’s Harborview Medical Center, deploys mobile teams for the arduous process of first tracking down homeless patients across the city and then establishing and maintaining a care plan. The spectrum of services offered extends from coordinating psychiatric care to fulfillment of prescriptions for postoperative medications.

The teams in Seattle found that by getting to patients before they reached the point of needing emergency care, they were able to dramatically prevent the overuse of many procedures and therapies. To date, Seattle’s program has reduced hospital stays for its patients by 25% and cut emergency room visits by 50%. The direct contact allowed homeless patients more control in their care, giving them say, for example, over end-of-life use of feeding tubes, assisted breathing, and extended intensive care stays.

In another step to overcome this gap in care, hospitals are teaming up with respite care programs that offer housing to homeless patients as they recuperate from in-patient procedures or manage chronic conditions. Chicago’s Northwestern Hospital now contracts with Interfaith House to provide short-term housing, and since 2010 in Los Angeles, Recuperative Care Centers has placed more than 1,500 homeless patients in local motels for the critical first stage in their recovery. According to statistics from that program cited in 2014, the program had saved its associated hospitals more than $12 million.

In Toronto, the fledgling Palliative Education and Care for the Homeless (PEACH) program was launched to assist the city’s estimated homeless population of 5,000. A major piece of PEACH’s work is to ensure that homeless patients with terminal illnesses are provided hospice care and are able to die with dignity, away from the increased stress and discomfort of living on the streets.

“Our experience shows us that the majority of this population dies in social isolation,” said Dr. Naheed Dosani, who leads PEACH’s outreach program. “They die with very few people around them, very few supports, and it’s a tragedy.”

The increase in these types of palliative and respite care programs is needed to address the alarming rise in the elderly homeless population. The National Health Care for Homeless Council projects that the population will grow to more than 95,000 in the U.S. by 2050. Already, according to reports from groups that provide care for the homeless, between 2008 and 2014, there was a 50% jump in the numbers of patients over 50 years old.

Programs such as these work to fix a broken link in providing the care with dignity that all people deserve. This unfortunate gap in care, and the terrible human and substantial financial costs associated with it, will only continue to grow if we do not support more innovative models that address it head-on.

At Healthify, we are focused on coordinating services for vulnerable populations in order to better address the social determinants of health. If you’re interested in learning how, please contact us below!

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Topics: Healthify social determinants of health coordinated care

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