Community Education Crucial to Improving Hospice Access Among Unhoused Populations

Identifying patients and finding referral sources are two challenging issues when it comes to reaching homeless populations in need of hospice.

Improving equitable, quality care for homeless populations involves providing education to internal hospice staff and to community care partners and referral sources, according to Nycole Snodgrass, director of operations for hospice and palliative at Providence Hospice Los Angeles County and SoCal Palliative Care.

The California-based provider recently received grant funding and expanded its partnerships with a local branch of the U.S. Department of Veterans Affairs (VA) to expand their reach among homeless populations.


“Our primary partnerships were with homeless navigators within the hospital setting, directors of case management locally, and then our VA partners both in Long Beach and in west Los Angeles,” Snodgrass said at the American Academy of Hospice and Palliative Medicine (AAHPM) and the Hospice and Palliative Nurses Association (HPNA) Annual Assembly. “The additional layer that we really felt was instrumental to making this a success was education. Education for the staff who are going to be caring for this patient population, and education for the community partners who would be sending us these referrals.”

Hospices are challenged to care for patients who are unhoused, as some living situations can pose safety risks and make it difficult to provide quality care effectively, Snodgrass indicated. Seniors who live in vehicles, campers or on the street, for example, can be difficult to locate, for starters.

Providence recently received a $95,000 grant to expand efforts to reach patients experiencing homelessness in California. The funds have allowed for expanded training as well as stronger community partnerships, Snodgrass stated.


Among those partners are referring providers and board-and-care facilities, according to Dr. Martina Meier, executive medical director of hospice and palliative care at Providence. Creating and maintaining those relationships has strengthened the ability to provide timely care to patients in need.

This includes educating referral organizations on the unique needs of homelessness populations, Meier added.

“We are reporting on our intake [as our] business development team works on creating and maintaining relationships so that we continue to be able to serve the right patients,” she said during the assembly. “We were able to keep the time from referral to placement pretty short.”

Among the barriers are biases and misunderstandings regarding homelessness that referral sources can bring, often unintentionally, according to Meier.

To address these biases, Providence has integrated trauma-informed care methodologies into both their staff training and community education programs.

“In terms of our educational goals, what we realized is that we need to continue doing training, especially around bias awareness and making sure that bias training, as well as training around experiencing homelessness and what is specific about those peoples’ needs to go to incoming staff,” Meier said.

On a national scale, roughly half of homeless single adults in the United States are 50 or older, a rise from an estimated 37% in 2003, reported the American Society on Aging. Seniors 65 and older make up the “fastest growing age group” of homeless populations, the report indicated.

Hospice providers have increasingly sought ways to bridge the gaps. Some offer care in hospice houses or at shelters. These are often nonprofit hospices who typically finance these programs through philanthropic donations.

Additionally, many hospices have expanded services to address social determinants of health, including nonmedical needs such as transportation, meals, or assistance with medical equipment such as walkers, wheelchairs and canes.

Providing a safe environment to both receive and give care is a crucial part of reaching homeless seniors who could benefit from hospice, according to Meier.

“For the hospice, it enables us as providers to access our patients in a safe environment,” Meier said. “We have taken care of people in environments that were less predictable. Not having to worry about our staff is a huge relief. It also allows us to send medications to a boarding care [center], which is a normal address. We don’t have to worry about the patient not being able to be reached by our staff and our interventions. This definitely not only decreases our moral distress for staff, but being able to do this work in a safe setting for our patients is a huge boost to their morale.”

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