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Slide 1: HEALTH-RELATED ISSUES OF THE HOMELESS Dawn Wincek
Slide 2: Objectives:      To provide a definition of the homeless population. To identify the medical needs of the homeless population. To identify the barriers in providing medical care to the homeless. To identify interventions that are necessary for improving the medical needs of the homeless population. To assist healthcare providers in evaluating their own perceptions of the homeless population.
Slide 3: Introduction: My First Encounter with the Homeless
Slide 4: DEFINITION OF HOMELESSNESS:  Homelessness is the condition and social category of people who lack housing, because they cannot afford, or otherwise unable to maintain, regular, safe, and adequate shelter. Wikipedia
Slide 5: The Federal Bureau of Prima ry Health Care Description : An individual without permanent housing who may live on the streets; stay in a shelter, mission, single-room occupancy facility, abandoned building or vehicle; or in any other unstable or nonpermanent situation.  An individual may be “doubled-up”, when they are forced to stay with a series of friends or extended family members. 
Slide 6: Who are the Homeless?          Mental Disorders Alcohol/Drug Abuse Unemployment / Poverty Foreclosures / Unavailable Affordable Housing Medical Bankruptcy Abusive Relationships Natural Disasters Veterans Released Prisoners / Discharged Hospital Patients
Slide 7: How many are homeless?  Most recent report from U.S. Department of Housing and Urban Development (HUD) indicates down 12% from 2005-2007, to just under 672,000, 40% are families with children. January 2005, one day national count, a point-in-time count, town by town, to check the streets and shelters. 
Slide 8: Violence inflicted upon the homeless      Robberies Beatings Rape Shootings Burnings
Slide 9: Stereotypes of the Homeless:      Criminals Lazy, Unmotivated A Lifestyle choice Addicts Adult males
Slide 10: Most Frequent Medical Diagnoses:         Substance Use Disorders Depression Diabetes Hypertension Asthma Back pain Arthritis Anemia
Slide 11: Additional health concerns: Skin conditions  Dental problems  Foot care  Communicable diseases (HIV/AIDS, TB)  Injuries from extreme weather and living on the streets. 
Slide 12: National Health Care for the Homeless Council (NHCHC) Clinical Practice Guidelines: Adapting Your Practice: 1. General recommendations for the care of homeless patients 2. Treatment & recommendations for homeless patients with Diabetes 3. Treatment & recommendations for homeless patients with Chlamydial/Gonorrhea Infections 4. Treatment & recommendations for the homeless patient with Asthma
Slide 13: 1. 2. 3. 1. Treatment & recommendations for the homeless patient with HIV/AIDS Treatment & recommendations for the homeless patient with Cardiovascular Diseases Treatment & recommendations for homeless children with Otitis Media Treatment & Recommendations on Reproductive Health care for homeless patients.
Slide 14: Use of Nurse-Managed Clinics: Nursing assessment  Health education  Nursing interventions  Referral for treatment 
Slide 15: Healthcare experiences for the homeless:      Lack of control Lack of physical resources Lack of financial resources Limited access Lack of compassion
Slide 16: Maslow’s Hierarchy of Needs  Human beings are motivated by unsatisfied needs and that certain lower needs must be satisfied before higher needs can be satisfied.
Slide 17: Homeless perceptions of being homeless  Live in fear and feel unsafe Experience emotional distress Exclusion and invisibility  
Slide 18: Overcoming Barriers to Healthcare Building trust  Diet  Access  Nomadic Lifestyle  Medications 
Slide 19: Building Trust  History of mental illness and abuse. 25% of them have schizophrenia, major depression, or bipolar disease. 
Slide 20: Diet  Inexpensive foods are high in fats, cholesterol, and sodium.
Slide 21: Access  After-hours clinic time “Drop-in” time so that no appt is necessary. Small incentives  
Slide 22: Nomadic Lifestyle  They often travel across several neighborhoods, cities, and states over a month.
Slide 23: Medication Adherence Once-daily  Side effects: sedative and gastrointestinal  Route of administration  State’s Medicaid & SCHIP drug formularies.  No insurance  Immunizations & vaccinations 
Slide 24: Implications for Nursing & Advance Practice Nurses Community outreach  Case management  Client advocacy  Primary care  Mental health  Substance abuse 
Slide 25: Controversies “Housing First” Initiative  Universal Healthcare  Criminalization of the homeless  Deinstitutionalization of the Mentally Ill 
Slide 26: “Housing First” Initiative:  A push to get the homeless into real, permanent homes as the first remedy.
Slide 27: Would universal health care help end homelessness?  Universal health care can reduce the fiscal impact and social cost of communicable diseases and other illnesses.
Slide 28: Criminalization of the Homeless Laws and Ordinances
Slide 29: Deinstitutionalization of the mentally ill Deinstitutionalization of the mentally ill, was this the answer to their civil rights?
Slide 30: Conclusion Youtube Homelessness in America: “It ain’t pretty, but it’s beautiful”
Slide 31: References  Choucair, B. (2006). Health care for the homeless in America. American Family Physician, 74(7), 1099-100. Daiski, I. (2007). Perspectives of homeless people on their health and health needs priorities. Journal of Advanced Nursing, 58(3), 273-281. Gordon, A.J., Montlack, M.L., Freyder, P., Johnson, D., Bui, T., Williams, J., Aim-High Team. (2007). The Allegheny initiative for mental health integration for the homeless: integrating heterogeneous health services for the homeless persons. American Journal of Public Health, 97(3), 401-5. Horn, A. (2008). Medical care for the homeless elderly. Care Management Journals, 9(1), 25-30.   
Slide 32:  Kushel, M.B., Vittinghoff, E., & Haas, J.S. (2001). Factors associated with the health care utilization of homeless persons. Journal of American Medical Association, 285(2), 200-6. Lewis, J.H., Andersen, R.M., & Gelberg, L. (2003). Health care for homeless women. Journal of General Intern Medicine, 18(11), 9218. Motjabai, R. (2005). Perceived reasons for loss of housing and continued homelessness among homeless persons with mental illness. Psychiatric Services, 56(2), 172-8. Montauk, S. L. (2006). The homeless in America: adapting your practice. American Academy of Family Physicians, 74(7), 1132-8-   
Slide 33:  Nickasch, B. & Marnocha, S.K. (2009). Healthcare experiences of the homeless. Journal of the American Academy of Nurse Practitioners, 21(1), 38-46. Savage, C.L., Lindsell, C.J., Gillespie, G.L., Dempsey, A., Lee, R.J., & Corbin, A. (2006). Health Care Needs of Homeless Adults at a Nurse-Managed Clinic. Journal of Community Health Nursing, 23(4), 225-34. Savage, C.L., Lindsell, C.J., Gillespie, G.L., Lee, R.J., & Corbin, A. (2008). Improving health status of homeless patients at a nursemanaged clinic in the Midwest USA. Health and Social care in the Community, 16(5), 469-475. Zlotnik, C. & Zerger, S. (2008). Survey findings on characteristics and health status of clients treated by the federally funded (US) Health Care for the Homeless Programs. Health and Social Care in the Community, 17(1), 18-26.   