Systemic Challenges, Local Solutions: Health Equity at the Intersection of Medical and Social Services Sectors

Background: previous research highlights many barriers faced by individuals experiencing homelessness and nearing the end of life. Despite years of research examining the gaps in palliative and end-of-life care, people experiencing homelessness remain unsupported by both medical and social services systems. Objectives: this study examines health equity at the intersection of palliative and non-profit care for individuals experiencing homelessness in Calgary, Canada. We were guided by the Health Equity Framework to interpret our findings. Our aim was to identify actionable solutions within existing systems and explore strategies that can bridge silos between medical and social services. Proposed Methods: semi-structured interviews were conducted with seven service users of a mobile palliative care organization and 11 healthcare providers whose work intersected both medical and social services. Using inductive thematic analysis, supported by NVivo 14 software, we identified opportunities for promoting equitable palliative and end-of-life care. Results/Implications: three interconnected themes emerged where shifts in (1) provider attitudes, (2) governance and policy changes, and (3) improved access to resources/streamlined navigation, shaped access to care. This study emphasizes locally adaptable, equity-driven solutions, moving beyond identifying barriers to care. It also contributes to the dialogue on collaboration and inter-systemic reform to better support individuals experiencing homelessness and nearing the end of life. Our findings encourage health care professionals from social work and medical settings to come together to deliver equity-focused care and for accessible sharing and dissemination of information and resources. Keywords: palliative end of life care, health equity, homelessness, houselessness, resource navigation, community-based care