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Background: People experiencing homelessness face profound barriers to accessing palliative and end-of-life care, including stigma, fragmented services, and the lack of stable housing for hospice visits. As a result, many unhoused individuals die without comfort-focused care, social support, or dignity. Rocky Mountain Refuge (RMR) in Denver, Colorado, is one of only a handful of programs in the U.S. offering hospice support specifically for this population. By creating a safe space for those experiencing homelessness at the end of life, RMR fills a critical gap and offers lessons for advancing health equity in palliative care.
Methods: Between February and October 2025, an internal evaluation of Rocky Mountain Refuge (RMR) was conducted using stakeholder surveys and qualitative interviews. The objective of this study was to evaluate RMR's unique care model to: a) inform program improvement and b) lay the foundation for a scalable model. Sixty stakeholders were invited to complete an online survey (24 responses, 40% response rate), and five qualitative interviews were conducted with supporters and donors. These participants were selected for their insight into RMR’s mission, operations, and sustainability. All qualitative data were analyzed using Braun and Clarke’s six-phase thematic analysis framework.
Results: Six key themes emerged: (1) Mission and dignity: RMR restores humanity and respect to those often excluded from end-of-life care; (2) Awareness and understanding: public misconceptions and discomfort surrounding death and homelessness hinder engagement; (3) Operational and financial challenges: limited capacity and funding instability constrain sustainability; (4) Policy and political context: funding and regulations create uncertainty in a shifting landscape; (5) Community trust and connection: personal relationships and in-person engagement foster understanding and support; and (6) Visibility and impact: storytelling, data sharing, and partnerships strengthen awareness and credibility.
Conclusions: RMR represents an innovative, equity-driven model that restores dignity at the end of life for unhoused individuals. Findings highlight both the moral urgency and systemic challenges of sustaining such programs and underscore the importance of storytelling, community engagement, and policy navigation to advance equitable hospice and palliative care.