Challenges to Accessing Palliative care for Unhoused Older AdultsMelissa C Palmer, LCSW, ACHP-SW, APHSW-C, JD Aug 15, 2023
Living with a serious illness creates challenges to access to all healthcare, in particular palliative care. The intersection of being unhoused and an older adult creates a larger chasm to cross in order to receive the care and healing when seriously ill. Often as a palliative care social worker, the therapeutic intervention lies in connecting patients with basic needs like housing and transportation so that they are able to more reliably access services like home and clinic palliative care. People who are unhoused are in crisis, and making meaningful progress in therapy is a luxury they cannot afford. Although palliative care social workers are skilled clinicians, patient-based care sometimes means we go back to our equity and social justice roots to palliate through resource management.
The downward spiral of serious illness and becoming/living without a home can feel defeating and dehumanizing and to those experiencing the spiral. In a 2016 article by Hayashi, people who become homeless are primarily living with either serious medical or psychological illness, and this pre-existing illness becomes untreated and exacerbated by losing housing.
An article published in 2021 in Forbes magazine proposes that “homelessness is a healthcare problem” and that almost half (40%) of unhoused individuals are covered by Medicare/Medicaid insurance, and the other 60% are uninsured. Author Sachin Jain provides several creative options to provide care to those who are uninsured and unhoused, such as mobile medical outreach units, interdisciplinary approaches, and specialty care.
Ian M. Johnson & Michael A. Light illuminate ways that the Homeless Palliative Care (HPC) program is creative in providing services including “street based palliative care” to people living with serious illness in their article Pathways of Individuals Experiencing Serious Illness While Homelessness: An Exploratory 4- Point Typology from the RASCAL-UP Study