Homeless Health and Nursing Care

Nursing Care for Homeless

Homeless Health,Why Homeless Care is Needed,Steps for Homeless People,Health Issues of Homeless,Nursing Care of Homeless People,Identification of Health Issues,Research Needs to Study Homeless Health Issue,Future of Homeless Nursing Care

Homeless Health

    Ongoing armed conflicts and poor economic conditions are daily increasing the ranks of the homeless in the world through the creation of refugees and immigrants. The level of increase in the homeless population worldwide can only be estimated because of the continuous fluctuation of this population. 

    However, the World Health Organization as well as nongovernmental agencies managing the homeless around the world confirm that there are greater numbers each year.

Why Homeless Care is Needed

    In the United States, the increase in the number of homeless became a subject of local, state, and national concern in the 1980s, with the profile of the homeless changing from that of an older male with alcohol addiction to that of young men and women (21-39 years) who often entered homelessness accompanied by their young children (National Coalition for the Homeless, 2002). 

    In 1987 the federal government, in the Stewart B. McKinney Act, initially enacted legislation providing limited funding for health care for the homeless via the federally funded community health centers.

Steps for Homeless People

    Since the number of homeless continued to increase, this funding was reapproved in 1994. In this act a homeless person is defined as one who lacks a fixed, regular, and adequate night-time residence; and... has a primary night time residency that is 

(a) a supervised publicly or privately operated shelter designated to provide temporary living accommodations

(b) an institution that provides a temporary residence for individuals intended to be institutionalized

(c) a public or private place not designated for, or ordinarily used as, a regular sleeping accommodation for human beings

    This definition does not include individuals incarcerated by federal or state governments. (42 USC S 11302(c) Currently the Urban Institute estimates that in the US the number of individuals experiencing homelessness at some time within a given year is 3.5 million, with 39% (1.5 million) of this group being children (Urban Institute, 2000). 

    This estimate is flawed and minimal as it reflects only the homeless counted by agencies servicing the homeless. The homeless who are not included in this estimate are those who do not seek services from homeless shelters and reside outside, in abandoned buildings or cars, or with relatives or friends.

Health Issues of Homeless

    Homelessness and health are interrelated in three major ways: health issues may lead to homelessness; being homeless may predispose an individual to health threats; and homelessness can impact health by limiting one's access to health care. Health status can easily lead to homelessness. 

    When an individual with physical or mental illness or drug/ alcohol addiction is unable to maintain employment and housing-homelessness results. 

    Being homeless in a shelter setting exposes the individual to health threats (communicable diseases) from living in close quarters with others (primarily respiratory, gastro intestinal, and dermatological health threats) and exacerbates common health problems (colds, extremity swelling, foot lesions, etc .) due to shelter restrictions which require residents to rise early and leave the premises. 

    Being homeless also makes access to health care more difficult since most homeless individuals do not have health insurance, and most shelters do not have onsite health care providers or access to cost-free medications. Consequently, the homeless seek care for acute episodes of illness at their peak and do not seek preventive care.

Nursing Care of Homeless People

    Nurses and nurse researchers around the world have been in the forefront studying the health care needs of the incoming homeless (refugees and immigrants). The US nursing literature focuses primarily on the health of homeless US citizens who have descended into homelessness for various reasons (eviction, substance abuse, release from prison, domestic abuse, etc.). 

    Early research in this area was directed primarily at gathering demographic information related to the homeless, such as age, sex, reason(s) for homelessness, health care needs, etc. (Lindsey, 1995) and providing reports of the health care Needs of this population from newly developed nurse-managed clinics.

    Although reporting of demographic information has continued, in the last 5 years nursing research in this area has evolved in new directions. Qualitative studies to better understand the lives of the homeless and the homeless experience have been published (Rew, 2003; Huang & Menke, 2001; Morrell-Bellai, Goering, & Boydell, 2000). 

    New research instruments have been developed and validated with various subgroups of this population, and new theoretical frameworks have been offered to better explain the phenomenon of homelessness in particular homeless subgroups (veterans, single mothers, substance abusers, domestic violence victims, adolescents, Etc.).

Identification of Health Issues

    These research studies have expanded the base of nursing knowledge through examining areas unique to this population, such as the relationship of early childhood trauma and abuse to adult homelessness; identification of the stressors and coping behaviors of individuals (adults, mothers, and children) who are homeless; identification of the personal strengths of the homeless; and identification of the meaning and value of pets for the homeless. 

    Through these studies unique factors impacting the physical, mental, and spiritual health of subsets of the homeless have been identified and nursing interventions proposed to utilize this new knowledge in addressing their health issues. 

    Nurse researchers have also been active in developing mechanisms to include the homeless and their nursing care needs in nursing school curricula through service learning projects, faculty-managed care centers, and clinical homeless shelter rotations (Wilk, 1999).

Research Needs to Study Homeless Health Issue

    New research instruments have also been used in studies with the homeless. Some have been adapted and validated for use with the general homeless population and others developed and validated specifically for use with subgroups of this population, such as homeless sheltered women (Hogenmiller, 2004).

Future of Homeless Nursing Care

    In the future, nursing research related to the health of the homeless will expand on current new directions to include: 

(a) identification of how to incorporate preventive health activities for individuals in the homeless state

(b) empowering the homeless to become competent health care consumers

(c) identification of the unique elements and health care needs of second-generation homeless

(d) identification of a continuum of health care strategies for individuals with recurrent homeless episodes

(e) development of cost analyzes and cost sharing models with other health care institutions to provide needed health care that is cost effective