Barriers to Disease Management Among People Experiencing Homelessness with Life-Limiting Illness: A Secondary Data Analysis

Background and Purpose:

There is a growing number of policies across the U.S. that criminalize homelessness, and recent studies have demonstrated adverse public health outcomes as a result (Westbrook & Robinson, 2020). A particular challenge this population faces is the confiscation of medications during law enforcement encounters (National Law Center on Homelessness and Poverty), justified by assumptions about illicit and prescription drug abuse among unhoused individuals.

People experiencing homelessness also experience high rates of life-limiting illness, die at younger ages, and have higher disease burden than their housed counterparts (Roncarati et al., 2018; Tobey et al., 2017). Yet, this population continues to face multi-faceted barriers to access to quality palliative care and end-of-life (PCEOL) services and chronic disease management. Despite the recent efforts to study the impact of criminalization, little is empirically known about how these policies impact health management for unhoused individuals with life-limiting illness. The aim of this secondary data analysis is to examine the effect of criminalization of homelessness on barriers to disease management for unhoused individuals with life-limiting illness.

Methods:

This study uses data from a cross-sectional community-based participatory research project which surveyed adults experiencing homelessness in Denver, CO (Westbrook & Robinson, 2020). Data were obtained through the Inter-University Consortium for Political and Social Research. Descriptive statistics were examined for social demographics, frequency of contacts with law enforcement, and service referrals during law enforcement encounters. Binary logistic regression was used to assess the association of police confiscation of prescription medicine or supplies with participants who have life-limiting illness, controlling for social demographics including race and gender, mental illness, and substance abuse.

Results:

The original study included 484 adults experiencing homelessness. Nearly all participants reported one or more contacts with law enforcement. Twenty-seven percent (n = 133) of the sample met our criteria of having a life-limiting disease. Fourteen percent (n = 70), of participants reported receiving a service referral during at least one of those contacts. Only 5% of the sample who received a service referral also had a life-limiting disease. Life-limiting disease was found to be a statistically significant predictor for having medications confiscated by law enforcement in this dataset (p < 0.001). Mental illness, race, and drug or alcohol abuse were also statistically significant predictors (p < .05, p = 0.05, and p = .01, respectively).

Conclusions and Implications:

Building upon previous research, this study illuminates implications that criminalization policies have among people experiencing homelessness with life-limiting illness. While there are limitations in the data to understand the full context of situations where medications are confiscated, our results suggest that medications are primarily being confiscated from folks who likely need them. Our results also suggest that nonwhite individuals are more likely to have medications confiscated, further supporting the body of evidence that BIPOC unhoused individuals are more likely to be targeted by law enforcement. Future social work research and practice should focus on further understanding, and alleviating policy and social barriers to disease management and PCEOL services for unhoused folks with life-limiting illness.