Rethinking Palliative Care Through Three Institutional Ethnographic Stories of People Living With Homelessness and Life-Limiting Illness
Bibliographic Data
| ID | 13775426 |
|---|---|
| Authors | Courtney R Petruik (0000-0002-8666-6385, University of Calgary, AB, Canada, corresponding author), Katrina Milaney (0000-0003-4761-589X, University of Calgary, AB, Canada) |
| Year | 2025 |
| Volume | 62 |
| Pages | 469580251390760-469580251390760 |
| Publication date | 2025-11-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | INQUIRY The Journal of Health Care Organization Provision and Financing (JOURNAL) |
| Journal identifiers | ISSN: 0046-9580 • E-ISSN: 1945-7243 |
| Publisher | SAGE Publishing (PUBLISHER • US) |
| DOI | 10.1177/00469580251390760 |
| PMID | 41174989 |
| OpenAlex | W4415773315 |
| Language | EN |
| References cited | 25 |
Fifteen to thirty percent of Canadians have access to palliative care, with even fewer access opportunities for people with experiences of homelessness. Existing research identifies barriers to access but rarely shows how health and social institutions actively organize exclusion. Part of a larger study, this paper examines how health and social systems shape the need for community-based palliative and end-of-life care, using 3 stories from clients of the Community Allied Mobile Palliative Partnership (CAMPP). Using institutional ethnography, data were collected between Fall 2019 and Summer 2020. Sources included approximately 100 h of observation of the CAMPP team's work, 3 in-depth client interviews, and supplementary provider interviews. Data were analyzed to trace institutional processes that shape everyday experiences of illness and care. Findings reveal systemic demands like renewing insurance for medical equipment, restrictive housing rules, and standardized hospital protocols that overwhelm capacities of many people with experiences of homelessness. Rowan's story illustrates how bureaucratic requirements jeopardized his oxygen supply. Harriet's story shows the harm of being separated from her caregiver in housing and hospital contexts compounding distress and reluctance to receive care. Chapa's story demonstrates how fear and stigma delayed critical cardiology care. Overall, the clients valued CAMPP's persistent, relational, non-judgmental, and flexible approach. The team's independence from the mainstream health system mandates enabled responsive care but relies on precarious funding, constraining sustainability. Community-based palliative teams like CAMPP fill critical gaps in mainstream services by tailoring care to complex social realities. Their model shows the value of equity-informed, relational approaches, yet structural exclusion and precarious funding threaten long-term viability. Policy integration must sustain such programs without eroding the autonomy that enables them to deliver meaningful palliative and end-of-life care for people with experiences of homelessness
Distress · Ethnography · General partnership · Health care · Mainstream · Palliative care · Paternalism · Respite care · Stigma (botany · Grief, Bereavement, and Mental Health · Homelessness and Social Issues · Palliative Care and End-of-Life Issues · Social Work
Institutional Ethnography
An intersectionality-based policy analysis framework
Harm reduction services as a point-of-entry to and source of end-of-life care and support for homeless and marginally housed persons who use alcohol and/or illicit drugs
Troubling ruling discourses of health
Hospitals, clinics, and palliative care units
The Effect of Advance Directive Completion on Hospital Care Among Chronically Homeless Persons
Conducting Analysis in Institutional Ethnography
| Citation velocity | historical |
|---|---|
| Highly cited | No |