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Approaches in Caring for the Homeless

Approaches in Caring for the Homeless. Mellanie Hopkins March 9, 2010. Definition of Homeless. Lack a regular and adequate nighttime residence or… Have a primary nighttime residence that is A supervised shelter

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Approaches in Caring for the Homeless

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  1. Approaches in Caring for the Homeless MellanieHopkins March 9, 2010

  2. Definition of Homeless • Lack a regular and adequate nighttime residence or… • Have a primary nighttime residence that is • A supervised shelter • An 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).

  3. Causes of Homelessness • More people living in poverty • Decrease in affordable housing • Loss of single room occupancy buildings • Emergency demands on income • Alcohol and drug addiction • Limited transitional treatment facilities for deinstitutionalized mentally ill people (Stanhope & Lancaster, 2006).

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

  5. Epidemiology • 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 veterans • 50% of homeless women and children become homeless as a result of domestic violence.

  6. Epidemiology • 3% report having HIV/AIDS • 26% 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).

  7. Common Ailments • Infestations and skin ailments • PVD and hypertension • Diabetes and malnutrition • Respiratory infections and COPD • Trauma • Mental illness • Substance abuse • Communicable diseases • TB, HIV/AIDS, STDs (Stanhope & Lancaster, 2006).

  8. Healthy People 2010 Objectives Related to Poor and Homeless People • 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).

  9. Health Promotion • 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).

  10. Health Prevention • 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).

  11. Levels of Prevention - Primary • 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).

  12. Levels of Prevention-Secondary • 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).

  13. Levels of Prevention-Tertiary • 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.

  14. Ethical Issues – Barriers To Receiving Health Care • Social triaging • Instead 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 stigmatized • Being treated with disrespect • Homeless feel invisible to health care providers (Martins, 2008).

  15. Health Planning • 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).

  16. Conclusion • 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).

  17. References • 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.

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

  19. 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.

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