title: Shelter-based palliative care for the homeless terminally ill.
abstract: BACKGROUND
  The homeless have high rates of mortality, but live in environments not conducive to terminal care. Traditional palliative care hospitals may be reluctant to accept such patients, due to behavior or lifestyle concerns. The Ottawa Inner City Health Project (OICHP) is a pilot study to improve health care delivery to homeless adults. This is a retrospective analysis of a cohort of terminally ill homeless individuals and the effectiveness of shelter-based palliative care. As proof of principle, a cost comparison was performed.
  
  
  METHODS
  28 consecutive homeless terminally ill patients were admitted and died at a shelter-based palliative care hospice. Demographics, diagnoses at admission and course were recorded. Burden of illness was assessed by medical and psychiatric diagnoses, addictions, Karnofsky scale and symptom management. An expert panel was convened to identify alternate care locations. Using standard costing scales, direct versus alternate care costs were compared.
  
  
  RESULTS
  28 patients had a mean age 49 years; average length of stay 120 days. DIAGNOSES: liver disease 43%, HIV/AIDS 25%, malignancy 25% and other 8%. Addiction to drugs or alcohol and mental illness in 82% of patients. Karnofsky performance score mean 40 +/- 16.8. Pain management with continuous opiates in 71%. The majority reunited with family. Compared to alternate care locations, the hospice projected 1.39 million dollars savings for the patients described.
  
  
  CONCLUSIONS
  The homeless terminally ill have a heavy burden of disease including physical illness, psychiatric conditions and addictions. Shelter-based palliative care can provide effective end-of-life care to terminally ill homeless individuals at potentially substantial cost savings.
authors.affiliation: University of Ottawa, Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada. tpodymow@uottawa.ca
authors.forename: Tiina
authors.initials: T
authors.lastname: Podymow
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Turnbull
authors.forename: Doug
authors.initials: D
authors.lastname: Coyle
mesh_terms: D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D005260:Female; D040261:Harm Reduction; D006703:Ill-Housed Persons; D017051:Hospice Care / Q000191:economics / Q000379:methods* / Q000592:standards; D006801:Humans; D016224:Living Wills; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010166:Palliative Care / Q000191:economics / Q000379:methods* / Q000592:standards; D010360:Patient Transfer; D010865:Pilot Projects; D012189:Retrospective Studies; D019452:Terminally Ill