Intersection of Homelessness, End of Life, Substance Use and Mental Illness: Challenges for Homeless Veterans and Providers

Homeless Veterans at the end of life and the providers who serve them face a many challenges. In addition to the simultaneous demands presented by being both homeless and end of life, many Veterans also struggle with substance use and/or psychiatric disorders. Navigating the intersection of these challenges is complex, but unpacking the competing issues and identifying areas of overlap is critical to serving this vulnerable population. Using a three phase sequential mixed methods design the authors 1) surveyed homeless and end of life programs affiliated with the Department of Veterans Affairs (VA); 2) conducted interviews and focus groups with 136 Veterans with unstable housing and multidisciplinary VA and community staff in five cities in the United States (US); and 3) held a forum with national stakeholders to identify specific educational and policy recommendations to improve care. This paper reports on one of the most significant barriers to care to emerge from these data: the complexity of pain management in this population. Recommendations to address this complex interaction of care are discus