Homeless People: Advance Directives and Hospice-Palliative Care (Video 1:26 mins.)

When you see homeless people, you might wonder how they came to that condition, why some refuse to leave the streets, if they really care about their health. What about their end-of-life preparations? They probably aren't concerned about completing Advance Directives. Right? Wrong.

There are few studies on the homeless and their preparation for end-of-life care. However, a study by the Center for Bioethics at the University of Minnesota has some convincing results that homeless people do care about completing Advance Directives. The research involved fifty-nine homeless people recruited from drop-in centers. Half were given written instructions to complete Advance Directives in a self-guided manner. Others were given the same directions with guidance in completing them.

The overall completion rate was 44%. A higher completion rate of 59% was earned by those who received guidance in completing the forms. The rate of completion for the self-guided group was 30%. Among all participants who completed their Advance Directive forms, there was a significant decrease in the frequency of worry about death from 50% to 12.5%. Those who filled out the Advance Directive forms increased their plans to write down their end-of-life wishes (56% to 100%) and plans to discuss their related wishes with someone (63% to 94%).

This research concludes that homeless people can appreciate being afforded the opportunity to complete Advance Directives. Although some will complete the forms without help, when time is taken to assist them, they can be especially successful in participating in their end-of-life preparations.

You can read more here about this research from the “Journal of General Internal Medicine.”

This video describes St. Michael’s Nazareth House, where hospice and palliative care are provided for terminally and seriously ill homeless patients.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
“Hospice and Nursing Homes Blog”

Hospice and Palliative Care for the Homeless

Every urban city has them somewhere. Viewed too often as invisible humanity, they watch their cardboard requests for help filter through society’s windshields. Shivering in countless layers of clothing, they roam while preaching to unseen characters. They are homeless people who may or may not have lived in the past like any reader of this blog.

But what happens or should happen to millions of homeless people when they are terminally ill? Those with bodies racked with years of substance abuse can only last so long, especially when strong social supports and medical insurance are lacking. When each day is a struggle to meet basic needs, the odds of detailed planning of end-of-life care are slim.

“The Journal of the American Medical Association” discusses how to serve the terminally ill homeless population with these summary conclusions:

1) Needs of the homeless can best be met with a multidisciplinary team that addresses their complex needs.

2) Those who continue to abuse drugs must have frequent clinic visits, specific dosages of long-acting pain medications, and a written pain agreement.

3) Their end-of-life concerns must be discussed with them and documented.

4) Due to lack of finances, homes, and social supports, the homeless rarely receive inpatient hospice care. However, inpatient palliative care at hospitals can enhance the quality of their end-of-life experience.

Like everyone else, homeless people are entitled to all the benefits of dignified death journeys.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
Hospice and Nursing Homes Blog