Hidden in Plain Sight: Palliative Care for Undocumented Immigrants (TH348)

Abstract

•Describe three unique barriers that undocumented immigrants face when they are diagnosed with a serious illness.•Identify successful strategies for increasing access to hospice and palliative care services for undocumented immigrants.•Discuss how to anticipate common concerns and requests made by undocumented immigrants who are approaching the end of life. Currently more than 11 million undocumented immigrants live in the United States. Although they are able to receive emergency and some primary care services, undocumented and recent immigrants are unable to purchase health insurance and cannot access Medicaid or Medicare benefits, including hospice. Patient concerns regarding their immigration status and economic, cultural, and linguistic barriers may further limit access to medical care. Therefore, undocumented immigrants may only seek care when they develop refractory symptoms of advanced illness. In caring for recent or undocumented immigrants, palliative care providers often have to address a wide range of cultural, economic, linguistic, legal, and ethical challenges. In this session, an interdisciplinary team of presenters will illustrate these challenges and describe how each member of the interdisciplinary team can help to address them. We will provide practical suggestions for eliciting undocumented immigrants’ unique concerns and facilitating access to critical services. Through case examples, we will demonstrate how to address common end-of-life concerns, including repatriation to countries of origin and/or facilitating contact with family members living abroad; how to provide care to immigrants who are marginally housed or have limited caregiver support; and how to obtain palliative and hospice care for these patients. Presenters from different geographic regions will address state-specific barriers to quality end-of-life care and provide successful strategies for overcoming them. We will also discuss the unique losses and sense of isolation experienced by undocumented immigrants, as well as the ethical dilemmas faced by the providers who care for them.