Addressing the Challenges of Palliative Care for Homeless Veterans

Area of Science:

• Gerontology
• Public Health
• Health Services Research

Background:

• Veterans nearing end-of-life (EOL) with unstable housing face significant gaps in current palliative care and homeless support services.
• Existing programs often fail to meet the complex needs of this vulnerable population.

Purpose of the Study:

• To identify barriers and develop recommendations for improving end-of-life (EOL) care for homeless veterans.
• To enhance access to appropriate housing and integrated care services.

Main Methods:

• Multidisciplinary focus groups and interviews with community leaders, VA leaders, and homeless veterans across five cities.
• A national forum utilizing Nominal Group Process and Modified Delphi Process to generate and prioritize recommendations.
• Qualitative content analysis of transcripts and field notes.

Main Results:

• Identified key barriers including health decline impacting independence requirements for housing, symptom management challenges in homelessness, system discontinuities, restrictive VA regulations, and competition for care prioritization.
• Developed 12 recommendations to address these identified barriers.

Conclusions:

• Substantial improvements in EOL care for homeless veterans are achievable through policy reform.
• Recommendations include facilitating housing and care access, disseminating existing policies, enhancing cross-system education and communication, and piloting innovative care models like VA group homes or palliative care facilities using harm reduction.