Aging at the Margins: Integrated Inpatient and Hospice Care for Structurally Vulnerable Populations in Austria

• In Event: Aging and the Life Course Section Roundtables
  In Refereed Roundtable (90 minute): 13: Institutional Care Arrangements and Experiences

Abstract

In conservative welfare regimes, such as Austria, health care systems can reinforce social inequality by structuring access through institutional eligibility criteria. People experiencing homelessness, individuals without insurance, and those affected by addiction or severe mental illness often face intersecting vulnerabilities that render them formally or effectively ineligible for key health and long-term care services. While emergency treatment is generally available, appropriate inpatient, long-term, and hospice care remain largely inaccessible. Hospitals thus become temporary substitutes for missing social infrastructure, resulting in prolonged stays or discharge into precarious living conditions. Responsibilities across institutions remain unclear, and continuity of care is rare.
This contribution presents a sociological evaluation of an eight-bed inpatient facility established in Austria for structurally vulnerable populations. The facility offers respite, long-term, and hospice care, operates with a 24/7 interdisciplinary team of nurses and social workers, and emphasizes low-threshold, dignity-centered care. It represents a potential structural intervention moving beyond emergency governance toward sustained institutional inclusion.
The ongoing formative evaluation employs a mixed-methods design, combining routine administrative data (e.g., occupancy, requests), exploratory analysis of public visibility and diffusion, and qualitative interviews with patients and staff. After the first year, findings show consistent high occupancy (around 90%), substantial unmet demand, and growing interest from other organizations. Patients report health stabilization, feeling safe, and respectful treatment, including dignified end-of-life care. Staff highlight strong interdisciplinary collaboration. However, tensions arise in developing organizational routines that reconcile professional standards with residents’ complex realities, alongside questions of long-term sectoral responsibility and financial sustainability.
This case study illustrates both the potential and challenges of institutional innovation within a fragmented welfare regime. It shows that creating continuity of care for structurally vulnerable populations requires not only compassionate practice, but also organizational adaptation and cross-sector commitment. By reflexively accompanying this process, applied sociology contributes to institutionalizing inclusive and equitable care.

Authors

• Beate Kloesch

• Markus Hadler, University of Graz (Austria)