The Case for Homeless Palliative Care

People experiencing homelessness often have higher rates of chronic illness yet frequently lack access to routine and preventative care. Homeless palliative care is an emerging interdisciplinary field that focuses on improving the quality of life for people who are homeless and at the end of their life but also those who have serious, chronic, and life-limiting illnesses. This is a two-part blog series that will examine homeless palliative care.

This blog provides an overview of homeless palliative care and the need in Mecklenburg County. A future blog will explore promising practices and what it would take to address the local need for homeless palliative care.

WHAT IS HOMELESS PALLIATIVE CARE?

Palliative care, while often thought of as end-of-life care, actually serves a much broader population. It is a specialized approach to medical care that aims to improve the quality of life of people who have life-limiting illnesses by providing holistic care. For people who are homeless, homeless palliative care is vital because unstable living conditions often exacerbate health problems for this vulnerable group who typically have limited access to healthcare and limited family support. Homeless palliative care extends the principles of palliative care to people who lack stable housing and suffer from terminal or serious illnesses by ensuring dignity and providing compassionate support and personalized care.

BENEFITS OF HOMELESS PALLIATIVE CARE

Homeless palliative care not only ensures people experiencing homelessness are able to die with dignity, but it also helps address health disparities by providing comprehensive, holistic care. There is a growing body of research that highlights the benefits and effectiveness of homeless palliative care programs. Studies suggests that homeless palliative care is a more cost-effective approach to care that reduces the burden on healthcare systems because it reduces unnecessary emergency room visits and inpatient hospitalizations. People who receive palliative care also report improved quality of life, improved pain management, higher satisfaction with care, and when coupled with housing, improved health outcomes. Finally, for those at end of life, receiving palliative care is associated with being able to die in their preferred setting, a core component of palliative care.

WHO NEEDS PALLIATIVE CARE?

Palliative care is for anyone who has a serious or life-limiting illness that impacts their quality of life or daily functioning. These illnesses include but are not limited to cancer, end-stage renal disease, advanced heart disease, liver failure, neurological diseases, and advanced HIV/AIDS. In addition, palliative care can benefit people who have frequent hospitalizations or ER visits, limited access to consistent care, uncontrolled symptoms, those in emotional, social, or spiritual distress as a result of or exacerbated by their illnesses, and those who have a poor prognosis or who are experiencing functional decline.

THE NEED IN CHARLOTTE-MECKLENBURG

Coordinated Entry is the front door to the homeless services system in Mecklenburg County. Coordinated Entry assessors complete a standardized assessment tool with people experiencing homelessness to gather information about their needs, vulnerabilities, and characteristics. One part of the assessment assesses health risks and captures data on various serious health conditions. An analysis of Coordinated Entry data for the first quarter of 2025 indicates a significant need for homeless palliative care.

Of the 749 adults assessed between January and March 2025:

• 17 indicated they had chronic kidney disease and were undergoing dialysis (2%)
• 25 reported chronic liver disease (3%)
• 2 people reported that they had both chronic kidney and liver disease and were undergoing dialysis
• 43 reported having a hemoglobin disorder (6%)
• 81 reported someone in their household had diabetes (11%)
• 153 reported having a heart condition (such as heart failure, coronary artery disease, cardiomyopathies or hypertension) (20%)
• 114 reported a chronic lung disease (including COPD (chronic obstructive pulmonary disease), asthma (moderate-to-severe), interstitial lung disease, cystic fibrosis, and pulmonary hypertension) (15%)
• 50 reported being immunocompromised due to a condition like cancer or HIV (7%)
• 68 reported having a terminal or end-stage disease, such as end stage renal disease, end stage liver disease, congestive heart failure, dementia, advanced cancer, pulmonary disease, or ALS (9%)
• Of the 294 people (39%) who reported at least one of these conditions, 148 people (20%) reported two or more

It is important to note that these statistics only represent adults who had a Coordinated Entry Housing Needs Assessment during the first three months of 2025. Therefore, these statistics represent the minimum need for palliative care among people experiencing homelessness in Mecklenburg County.