A House Is Not a Home

Abstract

There are intersecting, bidirectional relationships among trauma, poverty, the prison system, and racism for patients experiencing homelessness. Like those who are securely housed, those who experience homelessness suffer from serious and terminal illness and can be engaged by palliative social workers. People living in nontraditional settings not designed for habitation are, at best, invisible and, at worst, derided as problematic in medical settings. This chapter explores the challenges and importance of palliative care with vulnerable patients who are undomiciled, in shelters, in transitional housing, and those who may not consider themselves homeless and prefer terms such as “doubled up” or “living rough.” Using patient narratives, the chapter explores homelessness through a cultural lens, integrating assessment tools and clinical interventions to improve care and reduce implicit bias and intergroup disgust while strengthening provider empathy. Health social workers help to establish therapeutic rapport and build empathy among interdisciplinary teams working with people experiencing homeless.