title: Challenges of Providing End-of-Life Care for Homeless Veterans.
abstract: OBJECTIVE
  To describe challenges of caring for homeless veterans at end of life (EOL) as perceived by Veterans Affairs Medical Center (VAMC) homeless and EOL care staff.
  
  
  METHODS
  E-mail survey.
  
  
  METHODS
  Homelessness and EOL programs at VAMCs.
  
  
  METHODS
  Programs and their ratings of personal, structural, and clinical care challenges were described statistically. Homelessness and EOL program responses were compared in unadjusted analyses and using multivariable models.
  
  
  RESULTS
  Of 152 VAMCs, 50 (33%) completed the survey. The VAMCs treated an average of 6.5 homeless veterans at EOL annually. Lack of appropriate housing was the most critical challenge. The EOL programs expressed somewhat more concern about lack of appropriate care site and care coordination than did homelessness programs.
  
  
  CONCLUSIONS
  Personal, clinical, and structural challenges face care providers for veterans who are homeless at EOL. Deeper understanding of these challenges will require qualitative study of homeless veterans and care providers.
authors.affiliation: Denver Veterans Affairs Medical Center (VAMC), Denver, CO, USA Department of Medicine, University of Colorado School of Medicine, Denver, CO, USA evelyn.hutt@ucdenver.edu.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Hutt
authors.affiliation: Denver Veterans Affairs Medical Center (VAMC), Denver, CO, USA Department of Medicine, University of Colorado School of Medicine, Denver, CO, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Whitfield
authors.affiliation: Department of Medicine, University of Colorado School of Medicine, Denver, CO, USA.
authors.forename: Sung-Joon
authors.initials: SJ
authors.lastname: Min
authors.affiliation: University of Colorado College of Nursing, Denver, CO, USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Jones
authors.affiliation: University of Colorado College of Nursing, Denver, CO, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Weber
authors.affiliation: Department of Medicine, University of Colorado School of Medicine, Denver, CO, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Albright
authors.affiliation: Denver Veterans Affairs Medical Center (VAMC), Denver, CO, USA Department of Medicine, University of Colorado School of Medicine, Denver, CO, USA.
authors.forename: Cari
authors.initials: C
authors.lastname: Levy
authors.affiliation: Providence Veterans Affairs Medical Center, Providence, RI, USA Department of Medicine, Alpert Medical School, Brown University, Providence, RI, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: O'Toole
mesh_terms: D003266:Continuity of Patient Care / Q000458:organization & administration; D006703:Ill-Housed Persons; D006798:Housing; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology; D010166:Palliative Care / Q000458:organization & administration; D013727:Terminal Care / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
keywords: homelessness; palliative care; veteran