End-of-life care for people experiencing homelessness: A qualitative exploration of barriers and informal networks of care

The number of adults 65 and older experiencing homelessness will nearly triple by 2030 in the U.S. This population faces much higher rates of chronic and mental illnesses than the general population, with geriatric medical conditions similar to individuals at least 20 years older, and a mean age of death earlier than their housed counterparts. Yet, available services for end-of-life care are lacking for this population. This qualitative study explores perspectives on barriers and systems of end-of-life care for people experiencing homelessness among sixteen service providers. These interviewees highlight how bureaucratic structures, medical systems, shelter rules, and a lack of knowledge about people experiencing homelessness are major barriers to end-of-life care. Despite these larger structural issues, service providers create informal, flexible networks of resources and trusting client relationships. These informal networks reveal the need for deeper-reaching change to policies and structures to improve end-of-life care for people experiencing homelessness.