The Blog to Transform Advanced Care

Advancing Care through Innovation, Observation and Collaboration.

By: Andrew Lozano, Digital Marketing Intern, C-TAC

For many of the sickest and most vulnerable among us, the successful delivery of serious illness care is impeded by a lack of secure housing. As housing insecurity in the United States continues to skyrocket and is exacerbated by the unrelieved economic impact of the COVID-19 pandemic, our field must address the unique needs of unhoused individuals experiencing serious illness.

Research indicates that on a single day, an estimated 202,623 unhoused single adults in the United States are over the age of 50; therefore, more likely to need access to some degree of serious illness care.Despite a higher morbidity and mortality rate for these individuals, most do not engage in advance care planning and face numerous barriers to receiving palliative care. These can be as practical as lacking a mailing address and phone for provider correspondence or intangible, such as distrusting the healthcare system due to prior mistreatment. People who face the challenges of being unhoused may also be met with those of struggling with addiction, mental illness, and stigmatization. It is urgent that serious illness care meets people where they are; physically, mentally, and financially.

Housing insecurity exists across the country, though its burden is carried unequally among groups defined by decades of marginalizing, racist, and discriminatory policy. This creates challenges that our field must address through a lens of equity and anti-racism. C-TAC recognizes that achieving equity for the sickest and most vulnerable means working beyond the healthcare system. For example, we have launched a project in Louisville, KY which operates on the premise, affirmed by the National Health Care for the Homeless Council, that competing priorities are a major barrier to accessing quality care.

Elder Angela Overton, Senior Advisor to C-TAC’s Interfaith and Diversity Workgroup, oversees the work being done with the Louisville community and doesn’t view health inequities as just a problem where certain individuals receive lower standards of care based upon race. She views this as a profound moral and spiritual crisis as well; one that is far more related to life inequities.

“Individuals without the basic necessities; food, shelter, transportation, appropriate housing, and adequate wages, will not have a quality life,” says Elder Overton. “This should be a concern for all humanity. It must be placed on all of our agendas to find solutions where all individuals have the chance to live a quality life.”

Addressing these inequities means centering our work on the understanding that an individual’s capability to be healthy is heavily reliant on socially determined factors beyond the bounds of the current healthcare system, including secure housing. If we prioritize the issue, we can meet the unique challenges it poses to those in need of healthcare with adaptability and compassion. Recognizing the complexity of health reveals new ways to serve those who are most in need of empathy and compassionate care. This ensures that all who experience serious illness receive the comprehensive and quality care they need in a way that is consistent with their goals and honors their dignity, regardless of their circumstance.

As we head into the New Year, accompanied by one of the worst economic crises our country has faced, our field must adapt to reconcile the inequities in care fueled by socially determined disadvantages to meeting basic needs, such as secure housing. Only then can the serious illness movement meet the moment and advance the work of caring for the sickest and most vulnerable among us during these unprecedented times and beyond.

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