Family matters: advance care planning for people experiencing homelessness

Abstract

The number of homeless individuals in Minnesota in 2009 was estimated at 9,452 youth and adults. Homeless people have been shown to die at 3 - 10 times the rate of the general population and at a younger age. Additional reasons that suggest the great need of advance care planning in homeless populations include the assumption that impoverished populations have poor health care and personal relationships. However, in my qualitative analysis of 70 advance directives of individuals experiencing homelessness the most striking result was the importance of family; evident in responses to every question in the advance directive. Combining data from the advance directives and surveys, I discovered that 60% of individuals saw their family regularly, felt that their family cared about them, trusted their family to make decisions concerning them and named a family member as their health proxy. After realizing the important role family played in the end of life preparations of individuals experiencing homelessness, I coded the advance directive responses regarding family, and found six major themes. The most common theme was "evidence of strong family values and relationships." Literature concerning family relationships of single homeless adults is scarce, since emancipation from family is a widely exploited assumption and often considered a main cause of homelessness. However, these data show that adults experiencing homelessness in Minnesota have strong family connections and values and want their family to speak for them in cases of serious illness or death.