The Costs of Caring: I-Poems as Illustrations of Moral Distress Among Professionals Working with Seriously Ill Homeless Individuals

Both the recorded prevalence of moral distress among health and social service professionals (HSSPs) as well as the health needs of an increasingly older homeless population warrants further examination of how HSSPs experience and navigate moral distress when working with patients concurrently facing serious illness and homelessness. Through I-poems and iterative thematic analysis of 30 interviews, this study identified: (1) expectations versus reality, in which professionals contrasted advertised duties with actual tasks; (2) helplessness facing care constraints—felt experiences of powerlessness given current programming and funding; (3) disconnect from service users, how moral distress prompted bias in care decisions and avoidant behaviors in client interaction; and (4) reconciliation through community, or the social strategies professionals used to cope with or resolve moral distress. Findings from this study emphasize the importance of continued interventions for workforce development, adaptations to models of serious illness care for specialized populations, and efforts to create labor equity among healthcare and social services.