Date of Award


Document Type


Degree Name


Organizational Unit

Graduate School of Social Work

First Advisor

Leslie Hasche

Second Advisor

Michael Talamantes

Third Advisor

Daniel Brisson

Fourth Advisor

Jennifer Portz

Fifth Advisor

Jennifer Greenfield

Sixth Advisor

Roddy MacInnes


Health inequities, Homelessness, Hospice care, Palliative care


Although palliative and end-of-life (PEOL) care offer many benefits to individuals with life-limiting illness, unhoused individuals face barriers in accessing these forms of care. Despite calls over the last several decades to improve PEOL services for unhoused individuals, this population remains underprioritized in efforts to improve access to healthcare. A richer understanding of these inequities as they relate to the specific social and political contexts within a state, such as Colorado, may offer more direct guidance on opportunities to improve policy and care provision.

The purpose of this study was to explore healthcare and social service provider-identified approaches and challenges to serving unhoused adults with life-limiting illness in Colorado. A convergent mixed-methods design was used, including an online survey and semi-structured interviews. The survey included items to assess end-of-life competencies, attitudes towards homelessness, satisfaction with care, and barriers to care. Interviews focused on deeper accounts of provider experiences. Descriptive statistics and linear regression models were used to analyze survey data. Thematic analysis was used to evaluate qualitative data. Survey results and qualitative findings were merged and compared for mixed methods analysis.

A total of 67 healthcare and social service providers participated in the online survey, and 17 also completed individual, in-depth interviews. Survey results show that 30% of respondents were satisfied with care provided to unhoused individuals with life-limiting illness within their organization. Lack of stable housing or informal care, mental illness, substance use, complex care needs, and lack of community resources were identified most commonly as challenges in providing care. Interviews highlighted person-centered and holistic approaches to care, as well as challenges of providing complex care in the context of an inhumane lack of resources. Specialized PEOL interventions were discussed as possible solutions. Mixed methods findings provided deeper contextualization of the most frequently identified barriers to care in the survey.

The study findings further contextualize the barriers identified by providers in supporting unhoused individuals. Additionally, findings highlight potential pathways to improve support PEOL needs for unhoused individuals through person-centered care partnered with organizational support and funding, as well as transformations in our societal narratives and practices of community care.

Publication Statement

Copyright is held by the author. User is responsible for all copyright compliance.

Rights Holder

M. Pilar Ingle


Received from ProQuest

File Format




File Size

155 pgs


Social work

Available for download on Thursday, August 01, 2024

Included in

Social Work Commons