A critical examination of ‘family’ caregiving at the end of life in contexts of homelessness: Key concepts and future considerations
Bibliographic record
Abstract
Identifying and addressing inequities in palliative care is an area of growing interest and importance. In this critical essay, we aim to challenge embedded assumptions about 'family' caregiving in white, Western systems (e.g. that of the nuclear family as carers) and focus on how the social determinants of health (SDOH; e.g. income and social protection, housing, education, food security) affect access to, and quality of, care at the end of life. More specifically, our analysis pays attention to what shapes the SDOH themselves including how racism, classism, heterosexism, and ableism become embedded and sustained in health and social institutions including palliative care. We begin by providing a brief discussion of the study of 'family' including the nuclear family standard and fictive kinship as an 'alternative' family form. Next, we focus on fictive kinship in two diverse populations - (1) street-involved youth who form street families; and (2) older adults who access care beyond nuclear families - that challenge embedded assumptions and help set a foundation for thinking about family and caregiving in contexts of inequities. Drawing on short vignettes, we then focus on emerging issues in palliative care and 'family' caregiving in contexts of homelessness and housing vulnerability. These issues include how caregivers in contexts of homelessness are, themselves, facing structural vulnerability; bio-legal family estrangement, reunification, and privileging; and how community service workers are filling both formal and informal caregiving roles. We conclude by delineating ongoing questions, research and practice gaps, and suggestions for future research in this area.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".