Homeless Health and Nursing Care

Homeless Health and Nursing Care Introduction

Homelessness is a growing global concern, exacerbated by ongoing armed conflicts, economic instability, and inadequate social support systems. The number of homeless individuals continues to rise worldwide, making it difficult to obtain accurate estimates due to the fluctuating nature of this population. Both the World Health Organization (WHO) and numerous non-governmental organizations (NGOs) confirm that the homeless population grows each year. This expanding population faces significant health challenges, necessitating specialized nursing care to address their unique health needs.

Homeless Health

Health and homelessness are intricately connected, with each influencing the other in multiple ways. Health issues can lead to homelessness, homelessness can exacerbate existing health problems, and the homeless experience can limit access to necessary healthcare services. For example, individuals with mental illness, physical disabilities, or substance use disorders may find it challenging to maintain employment or secure stable housing, increasing their risk of becoming homeless. Conversely, the homeless environment exposes individuals to various health risks, including communicable diseases, injury, and chronic illness, while also restricting their access to preventive and acute healthcare services.

Why Homeless Care is Needed

The need for specialized homeless care became a significant concern in the United States in the 1980s when the profile of the homeless population began to change. Previously, the homeless population was predominantly older males with alcohol addiction. However, during the 1980s, the demographics shifted to include younger men and women (aged 21-39 years) often accompanied by their young children (National Coalition for the Homeless, 2002).

In response to this growing crisis, the federal government enacted the Stewart B. McKinney Act in 1987, which provided limited funding for homeless healthcare through federally funded community health centers. However, as the homeless population continued to increase, funding for these services was reapproved in 1994. The McKinney Act defines a homeless person as one who lacks a fixed, regular, and adequate nighttime residence, and whose primary nighttime residence is:

1. A supervised publicly or privately operated shelter designated for temporary living accommodations.
2. An institution providing a temporary residence for individuals intended to be institutionalized.
3. A public or private place not ordinarily used as a regular sleeping accommodation for human beings.

This definition does not include individuals incarcerated by federal or state governments. According to the Urban Institute (2000), an estimated 3.5 million individuals in the United States experience homelessness at some point within a given year, with 39% (1.5 million) being children. However, this estimate is minimal, as it only includes those counted by agencies serving the homeless. Many homeless individuals do not seek services from shelters and reside outside, in abandoned buildings, vehicles, or with relatives or friends, making accurate counts difficult.

Steps for Homeless People

Given the growing number of homeless individuals, various steps are necessary to provide adequate care and support:

1. Improved Access to Shelters and Services: Expanding the availability of shelters and services that provide temporary accommodations and basic needs is crucial. These facilities should also offer connections to social services, healthcare, and employment opportunities to help individuals transition out of homelessness.
2. Comprehensive Healthcare Services: On-site healthcare services in shelters or accessible clinics can significantly improve the health outcomes of homeless individuals. Providing routine screenings, immunizations, mental health services, and addiction treatment can help address both immediate and long-term health needs.
3. Policy and Advocacy Efforts: Governments and organizations must advocate for policies that provide affordable housing, adequate healthcare, and social support for vulnerable populations. This includes revising eligibility criteria for assistance programs and increasing funding for homeless services.
4. Education and Employment Programs: Offering educational and job training programs can empower homeless individuals to improve their economic prospects, reducing their risk of long-term homelessness.

Health Issues of Homeless

Homeless individuals face a multitude of health issues due to their living conditions, limited access to healthcare, and the social determinants of health that affect this population. The interrelationship between homelessness and health is threefold:

1. Health Issues Leading to Homelessness: Health problems, such as mental illness, physical disabilities, or addiction, may prevent individuals from maintaining employment or stable housing, ultimately leading to homelessness.
2. Health Risks Associated with Homelessness: Living in homeless shelters or on the streets exposes individuals to various health threats, including communicable diseases (e.g., tuberculosis, influenza), injuries, and exacerbation of chronic health conditions. The lack of proper hygiene, nutrition, and rest further contributes to deteriorating health.
3. Limited Access to Healthcare: Homeless individuals often lack health insurance and face numerous barriers to accessing healthcare, such as lack of transportation, identification, and knowledge of available services. Consequently, they tend to seek care for acute illnesses only when symptoms peak and are less likely to engage in preventive healthcare practices.

Nursing Care of Homeless People

Nurses play a critical role in addressing the health needs of homeless populations. They are often on the front lines, providing care in various settings, such as shelters, clinics, mobile units, and community outreach programs. Nurse researchers have been actively involved in studying the health needs of the homeless, including refugees and immigrants, and developing targeted interventions to address these needs.

Early nursing research focused on gathering demographic information related to homelessness, such as age, sex, reasons for homelessness, and healthcare needs (Lindsey, 1995). These studies helped establish nurse-managed clinics and programs to provide healthcare services tailored to homeless individuals. Over time, nursing research has evolved to explore new areas, such as the experiences of homeless individuals, the development of specialized care models, and the identification of unique factors that impact the health of homeless subgroups (e.g., veterans, single mothers, substance abusers).

Identification of Health Issues

Nursing research has expanded the knowledge base related to homeless health by examining various areas unique to this population. Studies have identified relationships between early childhood trauma and adult homelessness, stressors and coping behaviors of homeless individuals (including adults, mothers, and children), and the personal strengths and resilience of the homeless. Additionally, research has explored the significance of pets in the lives of homeless individuals, recognizing their value for emotional support and companionship.

These studies have led to the development of nursing interventions that leverage new knowledge to address the health issues of homeless populations. For example, understanding the impact of early trauma on health outcomes can help nurses develop trauma-informed care approaches that are sensitive to the unique needs of homeless individuals.

Research Needs to Study Homeless Health Issues

Ongoing research is essential to better understand the health needs of homeless individuals and develop effective nursing interventions. Some of the areas that require further study include:

1. Development of New Research Instruments: Researchers need to continue developing and validating tools to assess the health needs of homeless individuals accurately. This includes adapting existing instruments for use with diverse homeless populations and creating new tools tailored to specific subgroups (e.g., sheltered women, adolescents, veterans).
2. Exploration of New Theoretical Frameworks: New theoretical models are needed to understand the complex dynamics of homelessness and health, including the factors contributing to recurring episodes of homelessness and the unique needs of second-generation homeless individuals.
3. Integration of Homeless Care into Nursing Education: Nurse researchers should develop innovative approaches to integrate homeless care into nursing curricula through service learning projects, faculty-managed care centers, and clinical rotations in homeless shelters (Wilk, 1999).

Future of Homeless Nursing Care

The future of nursing care for homeless populations will likely focus on several key areas:

1. Incorporating Preventive Health Activities: Identifying ways to include preventive health activities, such as vaccinations, screenings, and health education, in care plans for homeless individuals will be essential. Preventive care can help reduce the burden of disease and improve health outcomes.
2. Empowering Homeless Individuals as Health Consumers: Efforts should be made to educate and empower homeless individuals to become knowledgeable healthcare consumers. This includes providing information on navigating healthcare systems, advocating for their own health needs, and understanding their rights.
3. Addressing Unique Needs of Second-Generation Homeless: Research should focus on understanding the unique health and social needs of individuals who have experienced homelessness from childhood or adolescence and continue to face housing instability in adulthood.
4. Developing Continuum of Care Strategies: Identifying a continuum of care strategies for individuals with recurrent episodes of homelessness will be crucial. This may include creating flexible, person-centered care models that adapt to the changing needs of individuals over time.
5. Creating Cost-Effective Care Models: Developing cost analyses and cost-sharing models with other healthcare institutions will help provide necessary care in a cost-effective manner. Collaborative efforts between healthcare providers, social services, and community organizations will be essential in achieving this goal.

Conclusion

Homelessness presents complex health challenges that require targeted nursing interventions and comprehensive research. As the homeless population continues to grow, the need for specialized nursing care becomes more urgent. Nurses must be equipped with the knowledge, skills, and resources to address the unique health needs of homeless individuals and advocate for policies that promote their well-being. Future nursing research will play a pivotal role in shaping the care models and strategies needed to improve the health outcomes of this vulnerable population. By focusing on prevention, empowerment, and the development of innovative care models, nursing care for the homeless can be enhanced, ensuring better health and quality of life for all.