Journal of General Internal Medicine

, Volume 22, Issue 4, pp 427–434 | Cite as

Experiences With and Attitudes Toward Death and Dying Among Homeless Persons

  • John SongEmail author
  • Edward R Ratner
  • Dianne M. Bartels
  • Lucy Alderton
  • Brenda Hudson
  • Jasjit S. Ahluwalia
Original Article


Homeless persons face many barriers to health care, have few resources, and experience high death rates. They live lives of disenfranchisement and neglect. Few studies have explored their experiences and attitudes toward death and dying. Unfortunately, studies done in other populations may not apply to homeless persons. Exploring these experiences and attitudes may provide insight into life, health care, and end-of-life (EOL) concerns of this population.


To explore the experiences and attitudes toward death and dying among homeless persons.


Qualitative study utilizing focus groups.


Fifty-three homeless persons recruited from homeless service agencies.


In-depth interviews, which were audiotaped and transcribed.


We present seven themes, some of which are previously unreported. Homeless persons described many significant experiences with death and dying, and many participants suffered losses while very young. These encounters influenced participants’ attitudes toward risks and risky behavior: e.g., for some, these experiences provided justification for high-risk behaviors and influenced their behaviors while living on the streets. For others, they may be associated with their homelessness. Finally, these experiences informed their attitudes toward death and dying as well as EOL care; homeless persons believe that care will be poor at the EOL.


Findings from this study have implications for addressing social services, health promotion, prevention, and EOL care for homeless persons, as well as for others who are poor and disenfranchised.

Key words

homelessness death end-of-life care focus groups poverty 



The authors would like to thank the clients and staff of St. Stephen’s shelter; Holy Rosary Church; Listening House; Hennepin County Outreach Services; Health Care for the Homeless, Minneapolis; and Our Saviors Church who were so generous with their time, thoughts, and dedication to serving others. We would also like to thank LeeAnne Hoekstra for administrative support, Tybee Types for transcription, and Karen Howard for manuscript preparation.

This study was funded by the National Institute of Nursing Research, National Institutes of Health, grant no. RO3 NR008586-02.

Potential Financial Conflicts of Interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • John Song
    • 1
    • 2
    Email author
  • Edward R Ratner
    • 1
    • 2
  • Dianne M. Bartels
    • 1
    • 2
  • Lucy Alderton
    • 3
  • Brenda Hudson
    • 4
  • Jasjit S. Ahluwalia
    • 2
    • 4
  1. 1.Center for BioethicsUniversity of MinnesotaMinneapolisUSA
  2. 2.Department of Medicine, Medical SchoolUniversity of MinnesotaMinneapolisUSA
  3. 3.Division of Chronic DiseasesCity of Philadelphia Department of Public HealthPhiladelphiaUSA
  4. 4.Office of Clinical Research, Academic Health CenterUniversity of MinnesotaMinneapolisUSA

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