Johnson Ian M, Light Michael A
University of Tennessee College of Social Work, Knoxville, Tennessee, USA.
University of Washington, Seattle, Washington, USA.
J Soc Work End Life Palliat Care. 2023 Jul-Sep;19(3):209-228. doi: 10.1080/15524256.2023.2223772. Epub 2023 Jun 18.
The shifting age demographics of those experiencing homelessness in the United States expose shortcomings and barriers within homelessness response services and safety-net healthcare to address serious illness. The purpose of this study is to describe the common trajectories of patients concurrently experiencing homelessness and serious illness. As a part of the Research, Action, and Supportive Care at Later-life for Unhoused People (RASCAL-UP) study, the study uses patient charts ( = 75) from the only specialty palliative care program in the U.S. specifically for people experiencing homelessness. Through a thematic mixed-method analysis, a four-point typology of care pathways taken by people experiencing homelessness while seriously ill is introduced: (1) aging and dying-in-place within the housing care system; (2) frequent transitions during serious illness; (3) healthcare institutions as housing; and (4) housing as palliation. Implications of this exploratory typology include targeted, site-specific interventions for supporting goal-concordant patient care and assisting researchers and policy makers in appreciating heterogeneity in experience and need among older and chronically ill people experiencing homelessness and housing precarity.
美国无家可归者年龄结构的变化暴露出无家可归者应对服务和安全网医疗保健在应对严重疾病方面的缺陷和障碍。本研究的目的是描述同时经历无家可归和严重疾病的患者的常见轨迹。作为“为无家可归者提供晚年研究、行动和支持性护理”（RASCAL-UP）研究的一部分，该研究使用了美国唯一专门为无家可归者设立的专科姑息治疗项目的患者病历（n = 75）。通过主题混合方法分析，介绍了无家可归者在身患重病时所采取的四种护理途径类型：（1）在住房护理系统中衰老并就地死亡；（2）重病期间频繁转移；（3）医疗机构作为住所；（4）住房作为姑息治疗。这种探索性类型学的意义包括针对特定地点的有针对性干预措施，以支持符合目标的患者护理，并帮助研究人员和政策制定者认识到无家可归和住房不稳定的老年人及慢性病患者在经历和需求方面的异质性。
