Barriers to Healthcare for the Homeless Population

A homeless person is defined as someone “who lacks a fixed, regular adequate night time residence or a person who resides in a shelter, welfare hotel, transitional program or place not ordinarily used as regular sleeping accommodations, such as streets, movie theaters, cars, abandoned buildings, etc. ” (Cone, 2008, p. ). Homelessness is a growing problem in the United States that affects the psychological and physical aspects of its victims. Two of the fastest growing subpopulations of the homeless are single mothers and families.

The word homeless implies being extremely vulnerable and more susceptible to health problems.

The homeless population faces many health disparities, just a few are inadequate healthcare, prejudices, and lack of available resources. This paper focuses on identifying barriers to decrease health disparities among the homeless population. It also evaluates the presence of these barriers among healthcare professionals, why these barriers exist, and presents a possible solution to problems that the homeless population faces. The plan of action and the intended goal focuses on increasing awareness of the special needs that the homeless population require, while reducing hospitalizations and emergency room visits.

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Identification of Barriers The homeless population face many barriers when it comes to receiving quality healthcare. Healthcare providers should provide unbiased care to all patients. However, the homeless have been branded with a certain stigmata of being beligerant, dirty, drunks. They are usually uninsured and frequent the emergency rooms using them as their primary means for treatment of their chronic health problems. The majority of the homeless are usually brought in via the 911 system because they were found intoxicated on a park bench or lying under some trees.

During the winter and summer months the number of visits will increase with the severe weather changes. Some will even feign illness just to get a warm bed, some food and a bath. It is these patterns that incite the prejudices that the homeless experience in healthcare organizations. Due to the frequency that homeless people are brought in for intoxication, it is the status quo to “treat them and street them”. They are usually not provided a thorough assessment, because they are intoxicated and unkempt. It is common practice to let them sleep it off, get them some food and send them on their way when they wake up.

Healthcare professionals feel that these individuals are a waste of their time because no matter what treatment they provide the cycle will continue and they will return in a couple of days with the same health problems. Nurses also feel they are taking up precious emergency room beds from people who truly need them. The lack of resources for the homeless population is also a defining factor in the lack of quality healthcare that they receive. In many emergency rooms the only resources available for the homeless is a list of shelters. Some of these shelters have been closed down and the majority had 3-4 week waiting periods.

These shelters did not provide any means for healthcare, only food and a place to sleep for the night. If a shelter does have availability, then the individual would have to find transportation usually across town to be there by three o’ clock then wait in line and hope that the availability had not been filled. These individuals are provided a doctor’s name and a list of low-cost clinics by the nurses, in order to follow-up for their medical problems. It is a common occurance that proper follow-up is not going to take place, and the healthcare system is only contributing to the cycle of non-adherence.

Course of Action and Goals On average there are approximately three and a half million homeless in the United States (Basics of Homelessness, 2002). In order for nurses to properly treat the homeless, all biases need to be set aside and a better understanding behind the dynamics of the homeless population as well as their special needs must be identified. The homeless population will only increase with our current economic status. Jean Watson’s Theory of Caring states that “intentionality is the projection of awareness, with purpose and efficacy toward some object or outcome” (Leuning, 2001, p. 00). Healthcare organizations and nurses need to collaborate using intentionality. The vulnerability status of the homeless is higher than most due to their lack of basic human needs of food, water, and shelter. The homeless population succumbs to a variety of chronic illnesses and disease, such as tuberculosis, AIDS/HIV, malnutrition and severe dental problems. They also fall prey to parasites, frostbite, infection and violence (Basics of Homelessness, 2002). These reasons alone prove that the homeless population needs to receive specialized care designed around their lifestyles.

As one can see, this population is not going away and the problem will only continue to grow. It is up to nurses and other healthcare professionals to advocate for these individuals and help make a change by using specialized assessment tools and learning more about programs specifically for the homeless By ensuring that these individuals receive the proper follow up care through a collaborative effort of nurses, doctors, social workers, case managers, and psychiatric professionals, there will be a reduction in the amount of return emergency room visits and hospitalizations.

The National Healthcare for the Homeless Council (NHCHC, 2008) has been serving the homeless for over twenty years. They provide free healthcare for the homeless, which is tailored to meet the special needs of this vulnerable population. They not only provide free healthcare, but they help them to find housing, substance abuse programs and mental health counseling and medications. The NHCHC website also has a wealth of information on how to care for the homeless with different medical problems as well as how to manage their care from a hospital’s point of view.

The NHCHC are available to all emergency rooms and hospitals for intervention with the homeless. Their normal day of operation is conducted from a mobile clinic, providing free medical care in areas where high populations of homeless people congregate. The NHCHC have store- front clinics that are readily accessible to the homeless. Some of the mobile clinics will attempt to make contact with the most secluded of homeless people to ensure that their medical needs are met (NHCHC, 2008). For the individuals that want help etting off of the streets, the case managers and social workers place them in housing, admit them into detox programs, and help them find jobs. This organization has decreased the homeless populations in the Berkeley area by 60%, while also reducing the return visits to the emergency room and hospitalizations in those areas. Conclusion Nurses are patient advocates. Being an advocate entails providing a voice for our patients and ensuring that they receive the best possible care. This should be true for all patients, whether uninsured, homeless, migrant workers, or just unpleasant to care for.

Caring allows us to guide our beliefs and advocate for what we believe is right for all patients. In order to provide a truly caring relationship, all biases must be self-recognized and then placed aside for the betterment of our patients. Collaboration with the healthcare team provides our patients with consistent and thorough care. It may also open doors to new beginnings. The barriers identified among the homeless population were prejudice, inadequate healthcare, and a lack of available resources.

The cycle of the homeless patient is not hard to break with the help of available resources and a collaborative effort. Working with the National Healthcare for the Homeless Council will provide healthcare organizations the resources needed to provide adequate healthcare to the homeless. The NHCHC is only the beginning of change and all it takes is one phone call along with the intent to provide these individuals with the healthcare they deserve. This is the first step in breaking the cycle for the homeless population and relieving the strain placed on emergency rooms and hospitals.