Roundtable: Providing palliative care for homeless people facing end of life: Lessons from a VA study

This roundtable will explore the results of a Veterans’ Administration study of end of life (EOL) care for military veterans experiencing homelessness, who do not fit easily into traditional hospice and palliative care programs. The study sought to understand the breadth and depth of unmet need for EOL care among homeless veterans and the barriers and facilitators to providing them excellent EOL care. Fifty of 152 VA Medical Centers (33%) completed an email survey, revealing an average of 9.4 homeless veterans at EOL annually. Interviewees and focus group participants at four sites emphasized: (1) In spite of homeless Veterans' declining health, which prevents independent living or realistic plans to abstain, current housing options are too often limited to places that insist on functional independence and a clean and sober lifestyle. (2) Symptom management within the context of addiction, unstable housing and behavioral health problems is challenging. (3) Discontinuity of care between systems restricts EOL care delivery. (4) VA regulations pose significant challenges to collaboration with community providers. (5) Nonetheless, dedicated homeless and EOL program staff collaborate informally. Study advisors are developing (1) a series of VA policy and implementation recommendations, (2) new educational programs for VA and non-VA homeless and EOL care providers, and (3) a proposal to pilot-test a harm reduction housing model for homeless Veterans who need palliative care.