Numerous obstacles prevent patients with housing instability from utilizing medical services. For a study, researchers sought to ascertain if patients with heart failure who get care at United States Veterans Affairs (VA) medical facilities experience housing insecurity in relation to palliative care (PC) interactions and hospice services.
Congestive heart failure was the predominant diagnosis in the retrospective assessment of inpatients in VA hospitals from 2010 to 2020. Three groups of people were identified based on their housing stability: those who were experiencing homelessness, at risk of becoming homeless, and those who were securely housed. The stably housed cohort served as the analytic reference, and the primary outcome was a PC encounter during admission. To modify the chance of obtaining PC during the index admission, inverse probability weighting (IPTW) was determined.
The number of veterans was identified as 78,449. Veterans were classified as stable in their housing (n=64,843, 91.5%), experiencing homelessness (n=1,967, 2.8%), or at risk for homelessness (n=4,039, 5.7%). Veterans who were at risk for homelessness (n=484, 12.0%), veterans who were already homeless (n=161, 8.2%), and patients in stable housing (n=6,249, 9.6%) all received PC. After controlling for IPTW, it was shown that individuals at risk of homelessness got PC services similar to those who were securely housed (adjusted OR=1.06, 95% CI 0.94,1.19), while those who were homeless had decreased odds of obtaining PC services (adjusted OR=0.62, 95% CI 0.52, 0.75).
Veterans getting PC during heart failure hospitalization may be affected by housing stability. Supporting the programs demonstrated a commitment to easing suffering in life-limiting illness, notwithstanding the practical difficulties of providing PC and hospice to persons who were homeless.