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Palliative care for homeless persons

James J O'Connell, MD
Section Editors
Christine Ritchie, MD, MSPH
Maria J Silveira, MD, MA, MPH
Deputy Editor
Diane MF Savarese, MD


Homelessness affects up to one percent of the United States (US) population and is two to five times more prevalent in the US than in Western Europe. Despite this, the experience of serious illness, suffering, and impending death among individuals living chronically in shelters and on the streets is complex and poorly understood. Little has been written on this topic, making it difficult to formulate evidence based guidelines or describe best practices. This topic will discuss palliative care for homeless persons, reviewing the relevant literature in order to inform an evidence based but practical approach to these patients. Other issues related to the medical care of homeless persons are covered separately. (See "Healthcare of homeless persons in the United States".)


Few homeless persons receive primary care, let alone palliative care. The barriers to palliative care for homeless persons primarily relate to this population’s special needs and limited access to the health care system. Examples of these barriers include (see "Healthcare of homeless persons in the United States"):

Lack of health insurance — Without medical insurance or disposable income, homeless persons cannot afford the costs of care and medications.  

Comorbid psychiatric illness — Many homeless individuals suffer from comorbid psychiatric illness that makes them skeptical of institutions, fearful of crowds, and intolerant to bureaucracy. Estimates of the prevalence of severe mental illness range from 20 to 40 percent and substance use disorders from 30 to 50 percent [1,2].

Lack of transportation — Many homeless persons are not able to travel to and from medical clinics and/or health centers, which limits their ability to access ambulatory care services.


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Literature review current through: Sep 2016. | This topic last updated: Jan 28, 2016.
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