Dying on the streets: Homeless persons' concerns and desires about end of life care

John Song, Dianne M. Bartels, Edward R. Ratner, Lucy Alderton, Brenda Hudson, Jasjit S. Ahluwalia

Research output: Contribution to journalArticlepeer-review

79 Scopus citations


BACKGROUND: There is little understanding about the experiences and preferences at the end of life (EOL) for people from unique cultural and socioeconomic backgrounds. Homeless individuals are extreme examples of these overlooked populations; they have the greatest risk of death, encounter barriers to health care, and lack the resources and relationships assumed necessary for appropriate EOL care. Exploring their desires and concerns will provide insight for the care of this vulnerable and disenfranchised population, as well as others who are underserved. OBJECTIVE: Explore the concerns and desires for EOL care among homeless persons. DESIGN: Qualitative study utilizing focus groups. PARTICIPANTS: Fifty-three homeless persons recruited from agencies providing homeless services. MEASUREMENTS: In-depth interviews, which were audiotaped and transcribed. RESULTS: We present 3 domains encompassing 11 themes arising from our investigation, some of which are previously unreported. Homeless persons worried about dying and EOL care; had frequent encounters with death; voiced many unique fears, such as dying anonymously and undiscovered; favored EOL documentation, such as advance directives; and demonstrated ambivalence towards contacting family. They also spoke of barriers to EOL care and shared interventions to improve dying among the very poor and estranged. CONCLUSIONS: Homeless persons have significant personal experience and feelings about death, dying, and EOL care, much of which is different from those previously described in the EOL literature about other populations. These findings have implications not only for homeless persons, but for others who are poor and disenfranchised.

Original languageEnglish (US)
Pages (from-to)435-441
Number of pages7
JournalJournal of general internal medicine
Issue number4
StatePublished - Apr 2007

Bibliographical note

Funding Information:
We conducted a qualitative investigation utilizing focus groups of homeless individuals. The study was funded by the NIH/

Funding Information:
Acknowledgements: The authors would like to thank the clients and staff of St. Stephen’s shelter; Holy Rosary Church; Listening House; Hennepin County Outreach Services; Health Care for the Homeless, Minneapolis; and Our Saviors Church who were so generous with their time, thoughts, and dedication to serving others. We would also like to thank LeeAnne Hoekstra for administrative support, Tybee Types for transcription, and Karen Howard for manuscript preparation. This study was funded by the National Institute of Nursing Research, National Institutes of Health, grant RO3 NR008586-02.


  • Bioethics
  • End-of-life care
  • Focus groups
  • Homelessness
  • Poverty


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