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Utilization of Advance Care Planning for Homeless Adults: Case Studies

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Abstract

Given the barriers to advance care planning (ACP) and low utilization of outpatient advance directives in hospital settings, it is unclear if ACP in primary care for adults who have experienced homelessness is effective and a valuable use of clinical time. As part of our ACP Project, we examined the feasibility and outcomes of ACP in primary care for patients who have experienced homelessness. We found that such efforts had significant impacts on patients’ hospital care and allowed their wishes to be honored when they lost capacity for medical decision-making, particularly at the end of life. Here, we present six case studies demonstrating the outcomes of ACP in primary care for homeless adults and highlight lessons learned. To our knowledge, this is the first case series showing how ACP for homeless adults in primary care has been utilized during hospital care. Based on our findings, we believe that outpatient ACP even for the most socially vulnerable patients is feasible, often impactful, and should be integrated into routine primary care.

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Acknowledgements

The authors thank Lili Bohan, Associate Director of Valley Lodge, the West Side Federation for Senior and Supportive Housing, Inc.’s transitional shelter, and Elisa Wallman-Jacques, administrator of the Institute for Family Health’s Homeless Program, for their assistance and support.

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Authors and Affiliations

  1. Institute for Family Health, New York, NY, USA

    Laura Kaplan-Weisman, Jessica Tam & Casey Crump

  2. Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, IMI L5-40, Box 1029, New York, NY, 10029, USA

    Laura Kaplan-Weisman & Casey Crump

  3. Care for the Homeless, New York, NY, USA

    Laura Kaplan-Weisman

  4. Hunter-Bellevue School of Nursing, Hunter College, New York, NY, USA

    Jessica Tam

  5. Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Casey Crump

Authors
  1. Laura Kaplan-Weisman
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  2. Jessica Tam
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  3. Casey Crump
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Corresponding author

Correspondence to Laura Kaplan-Weisman.

Ethics declarations

All study activities were approved by the Institutional Review Board at the Institute for Family Health, protocol # 2312. Patient informed consent was obtained to discuss and document advance care plans but was not required for these case reports as the study uses only de-identified secondary data.

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Kaplan-Weisman, L., Tam, J. & Crump, C. Utilization of Advance Care Planning for Homeless Adults: Case Studies. J Urban Health 96, 726–733 (2019). https://doi.org/10.1007/s11524-019-00369-x

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  • DOI: https://doi.org/10.1007/s11524-019-00369-x

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