Homelessness can occur even in the most stable income families. Families that have a one income household can find themselves without employment suddenly from companies that are experiencing economic difficulties which lead to reduction in forces. The United States homeless populations decreased by one percent in 2011. The nation went from 643,067 homeless people to 636,017. The largest decrease was among homeless veterans. The number of homeless veterans declined from 75,609 in 2009 to 67,495 in 2011 (US Bureau of Statistics, 2012). Homeless families have many medical needs that need to be addressed by a health care provider. Nursing plans are based on the assessment of family needed and interventions should be individualized. In the following paper, the writer will provide an assessment of how homelessness affects family processes. Healthy People 2020 objectives related to homelessness are identified and, a list of nursing interventions was developed. Homeless families are mostly single parent families with women as head of household.
The age range is 20-35 years old. Members of the family are often from minority groups. The primary causes of homelessness are the inability to pay rent, overcrowding and family conflict. Homeless families experience extreme poverty which put the family at risk for numerous health conditions (US Bureau of Statistics, 2012). The more serious acute and chronic illnesses as well as mental illness and children are vulnerable for a wide range of disease processes. It is estimated that 90 percent of homeless mothers has a mental illness with substance abuse and children have a high rate of development impairment (Wagner & Menke, 2002). Mothers demonstrate a high level of intense stress along with inability to cope.
Children react to their homeless condition through hyperactive and aggressive behavior; their behavior can range from being withdrawn to becoming emotionally clinging (Wagner & Menke, 1992). The family’s life is marked by confusion, turmoil, constant chaos and stress so that family violence is common. Their lives are also commonly marked by crime and victimization. Homeless families commonly suffer from malnutrition, infections, a wide number of diseases, and mental health problems (Cotton & Roden, 2007).
The Homeless Family Assessment
Assessment can be performed from several approaches. Wagner and Menke (1992) emphasize the value of case management because it is a holistic approach, uses comprehensive knowledge of health and illness, and has the capability to screen for deviations from the norm. Case management is able to take into account the fragmented nature of the homeless family and the use of many different agencies in care. Because homeless families are extremely vulnerable populations with highly complex needs, the clinical nurse specialist is the most appropriate health care provider for these families (Wagner & Menke).
Healthy People 2020 Objectives
Healthy People 2020 has the general goal of improving mental health and access to mental health services. Among the objectives is the improvement of people with co-occurring mental disorders and substance abuse problems. Another objective is to make assessment, diagnosis, and treatment available for these people.
Nursing interventions need to focus on the mother’s strengths and allow her to maintain control over the family’s functioning. When homeless mothers have mental health problems, the first intervention should be providing access to care. Ensure a safe place for medications and adapt medication regimen. Provide for patient education and screen the children for physical and mental problems. Most especially, the clinical nurse specialist needs to collaborate and coordinate with ancillary care as the family will have ongoing issues. Health teaching must include all the psychosocial aspects of care and certain problems experienced by the family will require advocacy.
Nutrition should be the first concern after shelter and the strategies may involve coordination, referrals and advocacy as well as guidance and teaching. Lack of good nutrition and an adequate daily diet is a source of impairment in all areas. The clinical nurse specialist will also act as advocate both for individual homeless families and all families that require solutions to problems brought on by homelessness.
Nurse Case Manager and the Homeless Family
The homeless family would benefit from the assignment of a case-manager. The case manager may encounter the homeless mother with children on the streets in a situation of extreme instability. The case manager will follow the family and monitor any physical and mental health issues and make sure that the family is having proper care.
Although homeless families are decreasing slightly in the United States, it is still a high-risk area. A large proportion of these families are made up of single mothers with at least one child. The families are very vulnerable to acute and chronic physical and mental conditions while they have little or no access to care. Families can find themselves abruptly in the most extreme and stressful situation but they still have certain strengths as is observed in the fact that these families are intact. Single mothers of these families manage to maintain family functioning despite the odds. Stress as experienced by homeless mothers is intense and can lead to or exacerbate mental illness.
Rather than focusing on mental illness, the health care provider needs to make shelter, nutrition and rest the main priorities because they contribute to mental health. Case management is the best approach to serve the needs of the homeless families. The health care provider’s role is teaching and counseling. One of the most valuable roles to the family is for the health care provider to be an advocate for them.
Amerson, R. (2008). Mental illness in homeless families. The Journal for Nurse Practitioners, 4(2), 109-114. Cotton, A. & Roden, J. (2007). Using patterns of knowing in nursing as a possible framework for nursing care of homeless families with children. Contemporary Nurse, 23(2), 331-342. Healthy people 2020: The road ahead. (2008). Journal of Environmental Health, 70(10), 82. Retrieved from http://search.proquest.com/docview/219721672?accountid=458 United States Bureau of Statistics, 2012 retrieved from www.usbureauofstatistics.gov
Wagner, J. & Menke, E. (1992). Case management of homeless families. Clinical Nurse Specialist, 6(2), 65-71.