I think that it is those kinds of cases that are more salient in my mind. (Physician)” Second, participants noted that poor discharge planning placed an undue burden on community agencies ill-equipped to provide end-of-life care services. Participants reported that homeless LY317615 persons were frequently discharged directly to emergency shelters even though these settings could provide only limited Inhibitors,research,lifescience,medical care to clients with complex medical needs. For example: “There is no discharge planning for this population. They are pushed

out of the hospitals to make room for beds because there are bed shortages. They do very little in the way of planning to discharge homeless people. They are easily

shoved to the street or shelter…You have incidents where you are having people dropped off [at the emergency shelter] by ambulance. Over the last month, they have been a little bit more courteous in calling. I think that has to do with Inhibitors,research,lifescience,medical the recent death of this fellow but I won’t bet that it will continue Inhibitors,research,lifescience,medical because there doesn’t seem to be a lot of continuity there. (Shelter director)” Participant recommendations to improve the end-of-life care system Low-threshold strategies Participants strongly recommended that the end-of-life Inhibitors,research,lifescience,medical care system adopt low-threshold approaches, which have minimal requirements for admission and care. Participants emphasized that conventional approaches requiring drug or alcohol abstinence restricted access to end-of-life care services for substance-using homeless populations. Participants reported that it was important that end-of-life care providers acknowledge that changes to rules and regulations were needed for the purpose of serving this population. Some participants noted that integrating harm reduction strategies for alcohol

Inhibitors,research,lifescience,medical use (i.e. prescribing alcohol and managing intake) and illicit drug use (i.e. providing clean needles and permitting off-site illicit drug use) were low-threshold strategies with the potential to improve end-of-life care services for this population. These participants observed that, although Furthermore, many participants all articulated that this adoption of harm reduction strategies expressed a commitment to serving homeless persons and awareness of this population’s life circumstances. For example: “People died outside on the streets because [end-of-life care providers] couldn’t provide that. We agreed to walk outside on the street with these people. [Harm reduction] is part of walking down the road, so that they don’t go out and drink Listerine.