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