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In this critical essay, we aim to challenge embedded assumptions about \u2018family\u2019 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 \u2018family\u2019 including the nuclear family standard and fictive kinship as an \u2018alternative\u2019 family form. Next, we focus on fictive kinship in two diverse populations \u2013 (1) street-involved youth who form street families; and (2) older adults who access care beyond nuclear families \u2013 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 \u2018family\u2019 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. 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