Mellanie Hopkins

March 9, 2010

Approaches in Caring for the Homeless

Lack a regular and adequate nighttime residence or…

Have a primary nighttime residence that isA supervised shelterAn institution that provides a temporary

residence to people that are intended to be institutionalized

A public or private place not designed for regular sleeping accommodations (Martins, 2008).

Definition of Homeless

More people living in povertyDecrease in affordable housingLoss of single room occupancy buildingsEmergency demands on incomeAlcohol and drug addictionLimited transitional treatment facilities for

deinstitutionalized mentally ill people (Stanhope & Lancaster, 2006).

Causes of Homelessness

http://www.youtube.com/watch?v=EDQA2yCQkC4&feature=related(Health This Week, 2009)

Video

3.5 million people are homeless over the course of a year.

Half are families with children.20% maintain full or part-time jobs.23% of homeless are veterans50% of homeless women and children become

homeless as a result of domestic violence.

Epidemiology

3% report having HIV/AIDS26% report acute health problems such as

TB, pneumonia, or sexually transmitted diseases

16% of single adult homeless population have serious mental illness (Stanhope & Lancaster, 2006).

Homeless adults have a mortality rate 4 times that of the general population.Average life span of a homeless person=45

years (CDC, 2010).

Epidemiology

Infestations and skin ailmentsPVD and hypertensionDiabetes and malnutritionRespiratory infections and COPDTraumaMental illnessSubstance abuseCommunicable diseases

TB, HIV/AIDS, STDs (Stanhope & Lancaster, 2006).

Common Ailments

Increase proportion of people with health insurance.Increase proportion of people who have a specific

source of ongoing care.Reduce the number of families that experience

difficulties or delays in obtaining health care.Reduce the number of homeless adults who have

serious mental illness to 19% from 25%.Increase employment of people with serious mental

illness from 43% to 51%.Increase the number of states from 24 to 50 that have

screening, crisis intervention, and treatment services for older adults (Stanhope & Lancaster, 2006).

Healthy People 2010 Objectives Related to Poor and Homeless People

Homeless use tremendous energy on obtaining food, shelter, and a place to rest (Nickasch & Marnocha, 2009).

Implement neighborhood education and interventions that promote health among people most at risk of becoming homeless (Schanzer, Cominguez, Shrout & Caton, 2007).

Health Promotion

Homelessness is associated with numerous risks that expose people to communicable infections which may spread among the homeless and lead to serious public health concerns (Badiaga, Raoult & Brouqui, 2008).

For the homeless, health care is crisis oriented and usually found in emergency departments (Stanhope & Lancaster, 2006).

Health Prevention

Vaccination against hepatitis B virus, hepatitis A virus, influenza, Streptococcus pneumoniae, and diptheria

Distribution of free condoms.Improvement of clothing and bedding

hygiene.Provide disease prevention education in areas

heavily populated with homeless (Badiaga, Raoult & Brouqui, 2008).

Levels of Prevention - Primary

Screening for TB in shelters.Mental health screening in shelters and

homeless areas.Use of ivermectin for scabies and body lice.

Scabies and body lice infestations lead to pruritus which may result in bacterial superinfections (Badiaga, Raoult & Brouqui, 2008).

Levels of Prevention-Secondary

Providing services and treatment directly to the homeless individual’s location (Drury, 2008).

Provide access to medication in homeless neighborhoods for patients requiring consistent pharmacological treatments.

Levels of Prevention-Tertiary

Social triagingInstead of being triaged by health care needs,

homeless may be triaged according to the ability to pay.

No system in place for health care of the homeless

Being labeled and stigmatizedBeing treated with disrespectHomeless feel invisible to health care

providers (Martins, 2008).

Ethical Issues – Barriers To Receiving Health Care

Patients who have no place to rest, bathe, cook, or store medicine require creative care planning.Tailor education to targeted populations

focused in areas where homeless reside.Draw on a person’s strengths and inner

resources.Emphasize full participation by the individual

(Billings & Kowalski, 2008).

Health Planning

Homeless individuals feel they are not in control of their health needs.

Healthcare providers must be aware that basic physical needs must be met before trying to address health related concerns (Nickasch & Marnocha, 2009).

Homeless people deserve respect while seeking health care.

Nurses need to build on the strengths and inner resources of the homeless rather than try to overcome their problems (Martins, 2008).

Conclusion

Badiaga, S., Raoult, D., & Brouqui, P. (2008). Preventing and Controlling Emerging and Reemerging

Transmissible Diseases in the Homeless. Emerging Infectious Diseases, 14(9), 1353-1359. doi:10.3201/eid1409.080204.

CDC/National Center for Health Statistics. The Homeless. Center for Disease Control. Retrieved February 27, 2010, from http://www.cdcnpin.org/scripts/

population /homeless.asp.Drury, L. (2008). From homeless to housed: caring for

people in transition. Journal Of Community Health Nursing, 25(2), 91-105. Retrieved from MEDLINE database.

References

Health This Week (2009, May 20). Health care for the homeless. (Video file). Video posted to http://www.youtube.com/watch?v=EDQA2yCQkC4&feature=related.

Martins, D. (2008). Experiences of Homeless People in the Health Care Delivery System: A Descriptive Phenomenological Study. Public Health Nursing, 25(5), 420-430. doi:10.1111/j.1525-1446.2008.00726.x.

Nickasch, B., & Marnocha, S. (2009). Healthcare experiences of the homeless. Journal of the American Academy of Nurse Practitioners, 21(1), 39- 46. doi:10.1111/j.1745-7599.2008.00371.x.

References

Office of Disease Prevention and Health Promotion. Community Setting and Select Populations. Healthy People 2010. Retrieved February 22, 2010, from http://www.healthypeople.gov /Document/HTML/Volume1 /07Ed.htm#_Toc490550859.

Schanzer, B., Dominguez, B., Shrout, P., & Caton, C. (2007). Homelessness, Health Status, and Health Care Use. American Journal of Public Health, 97(3), 464-469. doi:10.2105/AJPH.2005.076190.

Stanhope, M. & Lancaster, J. (2006). Foundations of nursing in the community: Community-oriented practice (2nd ed.) St. Louis: Mosby.

Zrinyi, M., & Balogh, Z. (2004). Student Nurse Attitudes Towards Homeless Clients: A Challenge for Education and Practice. Nursing Ethics, 11(4), 334-348. doi:10.1191/0969733004ne707oa.

References