Homelessness &End of Life Care

[unreadable] DESCRIPTION (provided by applicant): The American health care system has focused much deliberation and energy to providing good end of life care and a "good death." However, we have largely ignored those who die without loved ones by their sides, regular medical care, or safe and stable housing in our efforts to improve dying. End of life (EOL) care for homeless persons requires attention in our effort to transform the culture of dying in the U.S. for many reasons. This population is significant, with prevalence and incidence rates for homelessness far exceeding other populations previously studied by EOL researchers (e.g. people with AIDS or ESRD). Morbidity and mortality rates for homeless persons are several times higher than the general population. Homeless persons face many barriers to health care, and, presumably, to EOL care. Finally, the personal and cultural differences that characterize living without safe shelter may influence the very conception of good EOL care and/or a good death. This proposed project will utilize qualitative methodology to explore the conceptions, concerns, and desires of homeless people regarding EOL care, dying, and death. It builds upon preliminary work performed to explore topic relevance and project feasibility and to guide research design. Analysis of these data strongly suggests that EOL care is important to homeless people, and the concerns of homeless people regarding dying and death are often quite different than those described within other groups. We know of no conceptual or empirical work in this area. The specific aims of this project are to: 1) explore the conceptions, concerns, and desires of homeless individuals regarding dying, EOL care, and death; 2) identify the barriers that homeless individuals have to quality EOL care; 3) describe the interpersonal relationships and communication challenges of homeless people regarding dying, EOL care, and death; 4) identify possible interventions to improve care of those who are seriously ill or dying and experiencing homelessness. [unreadable] [unreadable]