Abstract
Abstract The culture change movement has fostered an intentional move away from restrictive ethos of care in hospitals, post-acute rehabilitation, and skilled nursing. However, for the millions in the United States who are uninsured, Medicaid-insured, or dual-eligible are less likely to access ‘deinstitutionalized’ healthcare environments. This presentation presents findings from a constructivist grounded theory study, Research and Supportive Care at Later-life for Unhoused People (RASCAL-UP), on the role of skilled nursing in the experiences of palliative care patients with histories of homelessness. Through provider interviews (n=30), field observations (n=12), and longitudinal chart documentation of a subset of homeless palliative care patients with stays in skilled nursing (n=13), this presentation will reflect on major findings: (1) barriers to skilled nursing entry; (2) successes and challenges in transitioning into skilled nursing residence; (3) acts of resistance to (re)institutionalization; and (4) discharge options and outcomes. Results showcase a need to fill the residential service gap between supportive housing and skilled nursing care and policy change that incentivizes consumer-directed practices for all.
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