Emerging Palliative Care Interventions for Homeless Adults
Exploring Initiatives In Ten US Cities with the Largest Homeless Populations
By Arden O’Donnell MPH, MSW, doctoral student at Boston University School of Social Work
This article was originally published by The Institute for Health System Innovation & Policy.
America’s homeless population is growing older. On city streets as well as in food banks, soup kitchens, and shelters, we are witnessing an increase in the numbers of gray-haired, stooped, and frail bodied individuals experiencing homelessness. Federal statistics also confirm the upward trend in the number of older persons facing homelessness and rise in the median age of the adult homeless population to 50.
Although these individuals are medically, socially and functionally vulnerable, and often face premature mortality, their complex and evolving needs often go unaddressed. In fact, little is known about palliative care resources that specifically target homeless adults in the U.S. A 2017 systematic review of scientific journals revealed only six intervention studies on palliative care and homeless adults, and none of the programs were U.S. based. Yet, anecdotally we are beginning to hear about local community initiatives.
The goal of our research project is therefore to identify emerging models of best practices in how the health care system is responding to the needs of homeless adults with serious, life-limiting illness. We are doing so through an environmental scan of the 10 cities (or COC’s- Continuums of Care) with the largest adult homeless populations in the U.S—Boston, Los Angeles, New York, Phoenix, San Diego, Santa Clara, CA, San Jose, San Francisco, Seattle, and Washington, DC. Through a web-based search of the “grey literature” (i.e., health organizations and professional associations reports, newsletters and media posts), we have currently identified 31 organizations in these 10 localities and are now in the process reaching out and conducting 45-minute zoom-interviews with the program directors.
These semi-structured interviews focus on gaining a deeper understanding of the program’s core aspects, including the nature of interprofessional collaboration, as well as learning about the successes and challenges in its development, implementation, and sustainability. We believe the study’s findings will help accelerate the knowledge and best practices in palliative care services, resources, and programs for adults with serious, life limiting illnesses at risk for and/or experiencing homelessness and provide valuable information to health care systems throughout the US seeking to address the complex and challenging needs of this population.
An interdisciplinary framework has been instrumental in the framing of this study and will also inform our data analysis and dissemination of the study’s findings. The World Health Organization (WHO) and the Institute of Medicine (IOM) emphasize the link between interprofessional healthcare teams and the provision of better health care services and practices. The medical subspecialty field of palliative care, which has interprofessional collaboration as a fundamental aspect of high-quality patient care, can provide expertise, experience, and leadership in the transformation of the broader health care system’s models of the delivery of care.
About Arden O’Donnell MPH, MSW
Arden O’Donnell received her MSW from Smith College and her MPH from Boston University. Her deep commitment to Palliative Care began with her work with HIV/AIDS patients in Zimbabwe and Lesotho. She began her professional career in Social Work as a Pediatric Palliative Care (PACT) Fellow at Children’s Hospital, then working on the Dana Farber-Brigham and Women’s Palliative Care Service. Arden currently teaches at the Smith College School for Social Work. She also founded the non-profit, Coalition for Courage, which provides health, education, and welfare services for children in Sub-Saharan Africa, especially those affected by HIV. In the summer of 2019, O’Donnell furthered her work as an IHSIP Summer Research Program awardee.