Barriers and facilitators to end of life care for homeless veterans
Methods: Using a two phase sequential design we 1) surveyed VA homeless and EOL programs and 2) visited four cities with sizable homeless populations, where we conducted interviews, focus groups and key stakeholder conversations with veterans, multidisciplinary providers and program leadership at the community and VA system level.
Results: There are important structural and interpretive differences between homeless and EOL programs. Interviewees and focus group participants emphasized the following themes. (1) Housing for homeless veterans that relies on ‘clean and sober’ models or functional independence conflicts with the growing number of homeless veterans whose declining health prevents living alone or realistic plans to abstain. (2) Pain management in the setting of addiction and end of life care is very challenging. (3) Discontinuity of care between systems and limited after-hours access to health professionals restricts EOL care delivery. Potential policy changes, collaborations and programs to facilitate high quality EOL care to homeless veterans will be explored.
Learning Areas:Clinical medicine applied in public health
Public health or related public policy
Identify and discuss barriers to providing high quality EOL care to homeless veterans. Formulate potential system changes and collaborations to facilitate high quality EOL care for homeless veterans.
Keyword(s): End-of-Life Care, Veterans' Health
Qualified on the content I am responsible for because: I am a Co-Investigator for a VA HSR&D funded grant on end of life needs for homeless veterans. I have been a principal or co-principal investigator on multiple federally and non-federally funded grants related to substance use and chronic mental illness. One of my scientific interests has been to improve the care for homeless individuals.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.