Abstract
Context
Patients experiencing housing insecurity have numerous barriers affecting their utilization
of medical care.
Objectives
Determine if housing insecurity is associated with palliative care (PC) encounters
and hospice services in patients with heart failure who receive care in United States
Veterans Affairs (VA) medical centers.
Methods
This retrospective study included inpatients in VA hospitals with a primary diagnosis
of congestive heart failure from 2010 to 2020. Housing stability was collected from
coding and separated into three cohorts: at risk for homelessness, experiencing homelessness, and stably housed. The primary outcome
was a PC encounter during admission and the stably housed cohort was used as the analytic
reference. Inverse-probability-weighting (IPTW) was calculated to adjust the likelihood
of receiving PC during the index admission.
Results
Seventy thousand eight hundred fourty nine veterans were identified. Veterans were
identified as at risk for homelessness (n=4039, 5.7%), experiencing homelessness (n=1967, 2.8%) and stably housed (n=64,843, 91.5%). PC was delivered to veterans at risk for homelessness (n=484, 12.0%), veterans experiencing homelessness, (n=161, 8.2%) and patients with stable housing (n=6249, 9.6%). Relative to the stably housed and adjusted for IPTW, those at risk for homelessness received PC services similarly (adjusted OR=1.06, 95% CI 0.94,1.19)
and those experiencing homelessness were at lower odds of receiving PC services (adjusted
OR=0.62, 95% CI 0.52,0.75).
Conclusion
Housing stability may be a factor in Veterans receiving PC during hospitalization
for heart failure. While the logistical challenges of delivering PC and hospice to
people experiencing homelessness are daunting, advocating for these services shows
commitment to reducing suffering in life-limiting Illness.
Key Words
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Article info
Publication history
Published online: July 24, 2022
Accepted:
July 21,
2022
Identification
Copyright
Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.
