As the years pass and the body matures, who can fight the need to reflect on life and death? Death especially is not the kind of topic you want to discuss while sharing your morning coffee, but the possibility of its imminent arrival in an unexpected way gives one pause.

For when the moment comes, we hope to be prepared. We hope not to suffer. We hope not to be lonely. We hope for a decent burial.

What can the homeless hope for?

“As the number of homeless people increases in our shelters and in New York overall,” said CHI Chief Program Officer Rosemary Dehlow, “one of the problems we face is the struggle with health issues and physical limitations. Years of neglected health care and the fact that chronically ill persons may not be able to work exacerbates the experience homeless families face with an end of life crisis.” And when the end arrives, their families do not have resources to honor their lives with a decent farewell.

It’s a vicious circle, poor health contributes to being homeless, and being homeless contributes to poor health. A recent case heightened concern in one of CHI’s shelters. A graceful woman in her mid-40’s, lost the battle against breast cancer, despite her positive attitude and desire to live. Homeless for about a year, she faced the discomfort of going in and out of the hospital to the shelter until she ultimately passed away.

“With the exception of obesity, strokes, and cancer,” said Ms. Dehlow, “homeless people are far more likely to suffer from every category of chronic health problem.” Conditions which require regular, uninterrupted treatment, such as tuberculosis, HIV/AIDS, diabetes, hypertension, addictive disorders and mental disorders, are extremely difficult to treat or control among those without adequate housing, according to the National Coalition for the Homeless, in a report about Health Care and Homelessness (2006).

On average, homeless adults have eight to nine concurrent medical illnesses. Mental illness is reported in 30% of homeless persons, and in 50% to 60% in homeless women. The usual chronic diseases are prevalent and difficult to manage, as reported in Medscape.

One of the CHI nurses who attended to our homeless client in her last days said, “I am grateful to have cared for such a wonderful person. Our conversations on a daily basis touched my life in many ways. She was special because she always said, “Thank you,” and always smiled even though she probably was in pain. She fought heroically until the end. She will be truly missed and is in the hearts of the CHI staff.” Several community members donated the funds needed for a cremation and a local church provided a small service. Our nurse gave the first donation.

Photo credit: Holy cross at Skogskyrkogården cemetery in the night of All Saints day, Stockholm, Sweden. (Wikimedia Commons)