Around 31% of Denver’s unhoused population is unsheltered, or living outside. While people experiencing unsheltered homelessness tend to face challenges accessing health care, one Colorado organization is focused on filling a glaring gap: end of life care.
Common terminal illnesses within the unhoused community include cancer and liver failure. People often struggle to access and manage a consistent pain management medicine regimen, with many living out their last days alone, in excruciating pain.
Rocky Mountain Refuge is a nonprofit on a mission to provide comfortable end of life care for the unhoused.
Inadequate End Of Life Care For Unhoused
Typically, unhoused people in need of end of life care have few options, and none are ideal. Under Medicare, an individual has access to just five days of proper hospice care and pain management. Shelters aren’t able to provide the level of hands-on, 24/7 care needed for someone with a terminal illness, and emergency departments may see people come in and out, with no proper coverage for an inpatient stay.
“Hospice care is designed to be in your home, with your family assisting. If you have no home, or you’re estranged from your family, people have serious problems accessing hospice care. Shelters are not designed to give people 24-hour care in a bed kind of situation. Hospices are not shelters, and they struggle quite a bit to provide this care,” said Br. James Patrick Hall, Executive Director of Rocky Mountain Refuge.
Rocky Mountain Refuge is the first nonprofit of its kind in Colorado, and the fourth in the nation to provide end of life care for people experiencing homelessness. The organization structures its approach to care around the social hospice model, developed in the 1980s as a response to the HIV/AIDS crisis. The social hospice model focuses on community organizations stepping in to perform the level of care a family would typically provide.
“When a person becomes ill, the rest of the world goes on by when you’re not able to go out and you’re staying in a tent or hotel. You can’t interact with people anymore. When people come to us, we have volunteers that come out and visit with them. We have staff that’s there 24/7 that they can talk to. Since we rent rooms from the Denver rescue mission, residents occasionally interact with folks that they know like that. There’s a lot of social interaction and human connection,” said Hall.
Social Model Hospice Care
Rocky Mountain Refuge partners with multiple hospice facilities across Denver to secure rooms for residents, and hires staff through Bayaud Enterprises. Residents typically stay with Rocky Mountain Refuge for an average of 10-14 days, with some staying longer. Staff and volunteers provide 24/7 care and companionship to provide a comfortable experience. On average, residents are in their early to mid-fifties. Caregivers work with residents to serve meals, assist with daily self-care needs and provide companionship. Nurses work with residents to administer medication and respond to other medical needs.
While residents occasionally have visitors from family or others in the unhoused community, Hall explained that an unhoused individual’s closest relationship is often with a pet. As animals aren’t allowed in emergency rooms or shelters, people risk being separated from their most important companion. At Rocky Mountain Refuge, all pets are welcome to stay with their residents, and are eventually rehomed through a partner animal shelter.
Providing hands-on care for pain management is an especially crucial element of Rocky Mountain Refuge’s work. Residents can rely on staff to manage and administer medication, where it’s stored in a safe facility. People who otherwise would have experienced constant pain towards the end of their life can be comfortable.
“It is very difficult to keep your medication on track when you are taking it yourself. When you’re unhoused, people can steal it from you. You might get confused about your schedule. For many of our residents, if they hadn’t come to us, they would have died in agony,” said Hall.
Dignified End of Life Care
Creating access to end of life care for the unhoused works to fill a major gap in healthcare for one of Denver’s most vulnerable populations. Residents are able to experience human connection, comfort and even joy during their time with Rocky Mountain Refuge. Staff and volunteers place an emphasis on creating joy, from bringing residents their favorite treats to sharing quality time together.
Similar to people suffering from HIV/AIDS amidst the initial crisis, unhoused individuals are treated as social pariahs and outsiders by society at large. The original social model for hospice care provided a respite for people who had nowhere to go, and no one to turn to. Rocky Mountain Refuge is rooted in building community and treats residents like family, if only for a short time. When a resident passes away, Rocky Mountain Refuge holds a memorial service.
Hall explained that Rocky Mountain Refuge is a growing nonprofit, and can only care for so many residents at a time. Currently, they have a waitlist for unhoused people in need of hospice care. With grants and the support of donors, Hall hopes to be able to provide care for everyone who walks through their doors.
“We are happy that every person that’s died in our facility so far, has died with someone present,” said Hall.