Ain't Never Been Cared for

Hospice and palliative care are difficult to access for patients who experience homelessness or vulnerable housing. These care models assume that patients are housed and have access to electricity and running water as well as food, safety, and social support. This constructivist grounded theory analysis examined the process of receiving hospice and palliative care for homeless and vulnerably housed individuals (HVHI). Addressing a gap in the literature, this study examined this process from the patient's perspective; while there is a growing body of literature that documents the barriers to care that this vulnerable group faces, very little evidence represents the patient perspective. Intensive interviews with nine participants provided the basis for a substantive theory: Ain't never been cared for: Receiving hospice and palliative care. The three-phase process experienced by participants and described in this dissertation includes Phase 1: Complex and Intersectional Trauma; Phase 2: Losing Health and Home; and Phase 3: Ain't never been cared for: Accessing Care and (Re) Creating Family. This theory of the process of receiving hospice and palliative care provides a framework for the improvement of clinical care, development of policy priorities, and clarification of educational needs for clinicians and other service providers. Through the lens of trauma informed care, clinicians can better serve this population by focusing efforts on harm reduction strategies, reducing barriers to care, and providing care in environments where HVHI feel safe; implementing harm reduction across care environments would additionally improve engagement with this population. Legislative priorities should focus on local, state, and federal policy development and funding to house the homeless. Additionally, policy to support the clinical practices of harm reduction strategies where HVHI can be reached, and services can be adequately provided is essential. Educational interventions for clinicians, students, and service providers will help to reduce barriers to care that impact the experience of bias and stigmatization by healthcare and other providers. Without a doubt, what people experiencing homelessness need is housing, and with housing, palliative and hospice services can improve the quality and quantity of life for this vulnerable population.