Resident Care in the “In-Between Time”: Cross-Sector Perspectives on Enhancing Synergy Between Palliative Care and Permanent Supportive Housing

Abstract

Despite established disparities in serious illness prevalence among formerly homeless people living in permanent supportive housing, there is a dearth of research aimed at promoting and enhancing palliative care service delivery in this setting. This paper describes current practices, perceived barriers, and recommendations in permanent supportive housing for residents living with serious illness through a thematic analysis of interviews with cross-sector stakeholders (n = 30) from the Research and Supportive Care at Later-life for Unhoused People (RASCAL-UP) study. Themes identified across resident care, program collaboration, and policy and environment areas included: (1) unique resident care needs; (2) on-site relationships; (3) adaptation of aging, disability, and healthcare services for residents; (4) internal implementation barriers; (5) preparing the environment for serious illness; and (6) missing levels of care. From these results, we put forth recommendations for future collaborative care intervention development, supportive housing policy, and capacity-building efforts for healthcare and housing providers alike.

Keywords

permanent supportive housing palliative care serious illness capacity building

Get full access to this article

View all access options for this article.

References

Baker

Evans

(2016). ‘Housing first’ and the changing terrains of homeless governance. Geography Compass, 10(1), 25–41. https://doi.org/10.1111/gec3.12257

Balagot

Lemus

Hartrick

Kohler

Lindsay

S. P.

(2019). The homeless coordinated entry system: The VI-SPDAT and other predictors of establishing eligibility for services for single homeless adults. Journal of Social Distress and Homelessness, 28(2), 149–157. https://doi.org/10.1080/10530789.2019.1622858

Bamberger

J. D.

Dobbins

S. K.

(2015). A research note: Long-term cost effectiveness of placing homeless seniors in permanent supportive housing. Cityscape, 17(2), 269–278. https://www.jstor.org/stable/26326949

Baruth

J. M.

J. B.

Mohammad

S. I.

Lapid

M. I.

(2021). End-of-life care in schizophrenia: A systematic review. International Psychogeriatrics, 33(2), 129–147. https://doi.org/10.1097/PSY.0b013e3182280016

Brekke

J. S.

Ell

Palinkas

L. A.

(2007). Translational science at the National Institute of Mental Health: Can social work take its rightful place? Research on Social Work Practice, 17(1), 123–133. https://doi.org/10.1177/1049731506293693

Britton

M. C.

Ouellet

G. M.

Minges

K. E.

Gawel

Hodshon

Chaudhry

S. I.

(2017). Care transitions between hospitals and skilled nursing facilities: Perspectives of sending and receiving providers. Joint Commission Journal on Quality and Patient Safety, 43(11), 565–572. https://doi.org/10.1016/j.jcjq.2017.06.004

Brown

(2022). The transfer of care: Psychiatric deinstitutionalization and its aftermath (Vol. 7). Routledge.

Brown

R. T.

Thomas

M. L.

Cutler

D. F.

Hinderlie

(2013). Meeting the housing and care needs of older homeless adults: A permanent supportive housing program targeting homeless elders. Seniors Housing & Care Journal, 21(1), 126–135. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3980491/

Canham

S. L.

Humphries

Moore

Burns

Mahmood

(2022). Shelter/housing options, supports and interventions for older people experiencing homelessness. Ageing & Society, 42(11), 2615–2641. https://doi.org/10.1017/S0144686X21000234

10.

Canham

S. L.

Weldrick

Sussman

Walsh

C. A.

Mahmood

(2022). Aging in the right place: A conceptual framework of indicators for older persons experiencing homelessness. The Gerontologist, 62(9), 1251–1257. https://doi.org/10.1093/geront/gnac023

11.

Center to Advance Palliative Care. (n.d.). Palliative Care definition. Retrieved March 26, 2023, from https://www.capc.org/about/palliative-care/

12.

Charmaz

(1999). Stories of suffering: Subjective tales and research narratives. Qualitative Health Research, 9(3), 362–382. https://doi.org/10.1177/104973239900900306

13.

Christian

Gozalo

Teno

Plotzke

(2022). An evaluation of the service intensity add-on payment policy reform in the Medicare hospice benefit. Journal of Pain and Symptom Management, 63(5), 876–877. https://doi.org/10.1016/j.jpainsymman.2022.02.073

14.

Corporation for Supportive Housing. (2016). Supportive housing 101: What is supportive housing? https://www.csh.org/supportive-housing-101/

15.

Culhane

Doran

Schretzman

Johns

Treglia

Byrne

Metraux

Kuhn

(2019). The emerging crisis of aged homelessness in the US: Could cost avoidance in health care fund housing solutions? International Journal of Population Data Science, 4(3). 1–20. https://doi.org/10.23889/ijpds.v4i3.1185

16.

Culhane

Metraux

Kuhn

(2018). A data-based re-design of housing supports and services for aging adults who experience homelessness. https://aisp.upenn.edu/wp-content/uploads/2019/01/LA-County-Report.pdf

17.

Davis-Berman

(2016). Serious illness and end-of-life care in the homeless: Examining a service system and a call for action for social work. Social Work & Society, 14(1). http://nbn-resolving.de/urn:nbn:de:urn:nbn:de:hbz:464-sws-964

18.

Dedoose Version 9.0.17. (2021). Web application for managing, analyzing, and presenting qualitative and mixed method research data. Sociocultural Research Consultants, LLC.

19.

DeRenzo

E. G.

(2021). Medical respite for the homeless: Moving from the present to the future. In Ritchie

E. C.

Llorente

M. D.

(Eds.), Clinical management of the homeless patient: Social, psychiatric, and medical issues (pp. 337–348). Springer. https://doi.org/10.1007/978-3-030-70135-2_21

20.

Deterding

N. M.

Waters

M. C.

(2018). Flexible coding of in-depth interviews: A twenty-first-century approach. Sociological Methods & Research, 50(2), 708–739. https://doi.org/10.1177/0049124118799377

21.

Doran

K. M.

Ragins

K. T.

Iacomacci

A. L.

Cunningham

Jubanyik

K. J.

Jenq

G. Y.

(2013). The revolving hospital door: Hospital readmissions among patients who are homeless. Medical Care, 51(9), 767–773. https://doi.org/10.1097/MLR.0b013e31829fafbb

22.

Giesbrecht

Stajduhar

K. I.

Mollison

Pauly

Reimer-Kirkham

McNeil

Rose

(2018). Hospitals, clinics, and palliative care units: Place-based experiences of formal healthcare settings by people experiencing structural vulnerability at the end-of-life. Health & Place, 53, 43–51. https://doi.org/10.1016/j.healthplace.2018.06.005

23.

Gill

Appley

Nix

Green

Gribbon

Divagaran

Jones

(2020). The homeless hospital liaison program: An interprofessional program to improve students’ skills at facilitating transitions of care for patients experiencing homelessness. Academic Medicine: Journal of the Association of American Medical Colleges, 95(3), 378. https://doi.org/10.1097%2FACM.0000000000003004

24.

Gomes

Calanzani

Gysels

Hall

Higginson

I. J.

(2013). Heterogeneity and changes in preferences for dying at home: A systematic review. BMC Palliative Care, 12(1), 1–13. https://doi.org/10.1186/1472-684X-12-7

25.

Gomez

(2018). A mobile wellness program for homeless in Los Angeles County, California: A grant proposal project [Master’s thesis, University of California-Long Beach].

26.

Göppner

H. J.

(2012). Response: Epistemological issues of social work science as a translational action science. Research on Social Work Practice, 22(5), 542–547. https://doi.org/10.1177/1049731512442250

27.

Greenfield

E. A.

(2018). Age-friendly initiatives, social inequalities, and spatial justice. Hastings Center Report, 48(S3), S41–S45. https://doi.org/10.1002/hast.912

28.

Han

B. H.

Moore

A. A.

Levander

X. A.

(2022). To care for older adults with substance use disorder, create age-friendly health systems. Health Affairs Forefront. https://www.healthaffairs.org/do/10.1377/forefront.20220505.917481

29.

Heller

Gresko

James

M. C.

(2021). Aging in supportive housing: A case study. Journal of Health Care for the Poor and Underserved, 32(2), 615–621. https://doi.org/10.1353/hpu.2021.0090

30.

Henwood

B. F.

Katz

M. L.

Gilmer

T. P.

(2015). Aging in place within permanent supportive housing. International Journal of Geriatric Psychiatry, 30(1), 80–87. http://dx.doi.org/10.1002%2Fgps.4120

31.

Henwood

B. F.

Harris

Woo

Winetrobe

Rhoades

Wenzel

S. L.

(2017). Availability of comprehensive services in permanent supportive housing in Los Angeles. Health and Social Care in the Community, 26(2), 207–213. https://doi.org/10.1111/hsc.12510

32.

Henwood

B. F.

Lahey

Rhoades

Pitts

D. B.

Pynoos

Brown

R. T.

(2019). Geriatric conditions among formerly homeless older adults living in permanent supportive housing. Journal of General Internal Medicine, 34, 802–803. https://doi.org/10.1007/s11606-018-4793-z

33.

Iles-Shih

Sve

Solotaroff

Bruno

Gregg

(2011). Health and illness in context: A pragmatic, interdisciplinary approach to teaching and learning applied public health within an urban safety net system. Journal of Public Health Management and Practice, 17(4), 308. https://doi.org/10.1097/PHH.0b013e31820f8e56

34.

Jego

Abcaya

Ștefan

D.-E.

Calvet-Montredon

Gentile

(2018). Improving health care management in primary care for homeless people: A literature review. International Journal of Environmental Research and Public Health, 15(2), 309. https://doi.org/10.3390/ijerph15020309

35.

Jensen

(2022). Social model hospice’s impacts on homeless recipients at the end of life: A qualitative exploration. Journal of Pain and Symptom Management, 63(5), 877. https://doi.org.libweb.lib.utsa.edu/10.1016/j.jpainsymman.2022.02.074

36.

Jones

Alony

(2011). Guiding the use of grounded theory in doctoral studies – An example from the Australian film industry. International Journal of Doctoral Studies, 6, 95–114. https://doi.org/10.28945/1429

37.

Kellehear

O’Connor

(2008). Health-promoting palliative care: A practice example. Critical Public Health, 18(1), 111–115. https://doi.org/10.1080/09581590701848960

38.

Klop

H. T.

de Veer

A. J. E.

van Dongen

S. I.

Francke

A. L.

Rietjens

J. A. C.

Onwuteaka-Philipsen

B. D.

(2018). Palliative care for homeless people: A systematic review of the concerns, care needs and preferences, and the barriers and facilitators for providing palliative care. BMC Palliative Care, 17(1), 67. https://doi.org/10.1186/s12904-018-0320-6

39.

Kwak

Nelson-Becker

(2015). What constitutes a good and bad death?: Perspectives of homeless older adults. Death Studies, 39(7), 422–432. https://doi.org/10.1080/07481187.2014.958629

40.

Krakowsky

Gofine

Brown

Danziger

Knowles

(2013). Increasing access—a qualitative study of homelessness and palliative care in a major urban center. American Journal of Hospice and Palliative Medicine, 30(3), 268–270. https://doi.org/10.1177/1049909112448925

41.

Krok-Schoen

J. L.

White

Clutter

Dabelko-Schoeny

(2022). White and black differences in perceived access to health and community services and self-rated health in an age-friendly community assessment. Journal of Applied Gerontology, 41(3), 628–637. https://doi.org/10.1177/07334648211023251

42.

Lee

C. T.

Guzman

Ponath

Tieu

Riley

Kushel

(2016). Residential patterns in older homeless adults: Results of a cluster analysis. Social Science & Medicine, 153, 131–140. https://doi.org/10.1016/j.socscimed.2016.02.004

43.

Lepore

M. J.

Shield

R. R.

Looze

Tyler

Mor

Miller

S. C.

(2015). Medicare and Medicaid reimbursement rates for nursing homes motivate select culture change practices but not comprehensive culture change. Journal of Aging & Social Policy, 27(3), 215–231. https://doi.org/10.1080/08959420.2015.1022102

44.

McCune

E. K.

Visser

M. R.

Bamberger

(2022). “Nobody wants to talk about it, especially in this building”: A qualitative study of how people living in permanent supportive housing approach end-of-life care. OMEGA - Journal of Death and Dying. Advance online publication. https://doi.org/10.1177/00302228221114756

45.

Mills

Bonner

Francis

(2006). The development of constructivist grounded theory. International Journal of Qualitative Methods, 5(1), 25–35. https://doi.org/10.1177/160940690600500103

46.

Mundt-Leach

(2016). End of life and palliative care of patients with drug and alcohol addiction. Mental Health Practice, 20(3), 17. https://doi.org/10.7748/mhp.2016.e1148

47.

National Consensus Project for Quality Palliative Care. (2018). Clinical practice guidelines for quality palliative care (4th ed.). National Coalition for Hospice and Palliative Care. https://www.nationalcoalitionhpc.org/ncp/

48.

Onwuegbuzie

Leech

Collins

(2010). Innovative data collection strategies in qualitative research. The Qualitative Report, 15(3), 696–726. https://doi.org/10.46743/2160-3715/2010.1171

49.

Pandit

S. G.

Brown

R. T.

(2021). Mitigating homelessness among older adults: Opportunities in adapting the permanent supportive housing model. Generations, 45(2), 1–15.

50.

Pathway. (n.d.). Homeless palliative care toolkit. Retrieved March 22, 2023, from https://www.homelesspalliativecare.com/

51.

Petruik

C. R.

(2018). Social work practices in palliative and end-of-life care for persons experiencing homelessness: A scoping review. Families in Society, 99(4), 317–328. https://doi.org/10.1177/1044389418808154

52.

Pynoos

(2018). The future of housing for the elderly: Four strategies that can make a difference. Public Policy & Aging Report, 28(1), 35–38. https://doi.org/10.1093/ppar/pry006

53.

Radbruch

De Lima

Knaul

Woodruff

Yong

Pastrana

(2020). Redefining palliative care—A new consensus-based definition. Journal of Pain and Symptom Management, 60(4), 754–764. https://doi.org/10.1016/j.jpainsymman.2020.04.027

54.

Riley

Sawka

Conley

Hewitt

Mitic

Poulin

Room

Single

Topp

(1999). Harm reduction: Concepts and practice. A policy discussion paper. Substance Use & Misuse, 34(1), 9–24. https://doi.org/10.3109/10826089909035632

55.

Roncarati

J. S.

Tiemeier

Tachick

VanderWeele

T. J.

O’Connell

J. J.

(2021). Housing boston’s chronically homeless unsheltered population: 14 years later. Medical Care, 59, S170. https://doi.org/10.1097/MLR.0000000000001409

56.

Serge

Gnaedinger

(2003). Housing options for elderly or chronically ill shelter users. Canada Mortgage and Housing Corporation. https://policycommons.net/artifacts/1197168/housing-options-for-elderly-or-chronically-ill-shelter-users/1750292/

57.

Shulman

Hudson

B. F.

Low

Hewett

Daley

Kennedy

Davis

Brophy

Howard

Vivat

Stone

(2018). End-of-life care for homeless people: A qualitative analysis exploring the challenges to access and provision of palliative care. Palliative Medicine, 32(1), 36–45. https://doi.org/10.1177/0269216317717101

58.

Sumalinog

Harrington

Dosani

Hwang

S. W.

(2017). Advance care planning, palliative care, and end-of-life care interventions for homeless people: A systematic review. Palliative Medicine, 31(2), 109–119. https://doi.org/10.1177/0269216316649334

59.

U.S. Department of Housing and Urban Development. (n.d.a). Permanent Supportive Housing (PSH). Retrieved February 7, 2023, from https://www.hudexchange.info/homelessness-assistance/coc-esg-virtual-binders/coc-program-components/permanent-housing/permanent-supportive-housing

60.

U.S. Department of Housing and Urban Development. (n.d.b). Reasonable accommodations and modifications. Author. Retrieved February 8, 2023, from https://www.hud.gov/program_offices/fair_housing_equal_opp/reasonable_accommodations_and_modifications

61.

Waldbrook

(2015). Exploring opportunities for healthy aging among older persons with a history of homelessness in Toronto, Canada. Social Science & Medicine, 128, 126–133. https://doi.org/10.1016/j.socscimed.2015.01.015

62.

Wirth

Mette

Prill

Harth

Nienhaus

(2019). Working conditions, mental health and coping of staff in social work with refugees and homeless individuals: A scoping review. Health & Social Care in the Community, 27(4), e257–e269. https://doi.org/10.1111/hsc.12730

63.

Zerden

L. D.

Lombardi

B. M.

Richman

E. L.

(2019). Social workers on the interprofessional integrated team: Elements of team integration and barriers to practice. Journal of Interprofessional Education & Practice, 17, 100286. https://doi.org/10.1016/j.xjep.2019.100286