Homeless Vulnerable Population

Homelessness Vulnerable Population
Eve Martinez
NUR/ 440
Karen Harriman
March 11, 13

The homeless population is a social group that is vulnerable because the homeless are at an increased risk for adverse health-related outcomes. Understanding the nature of homelessness and the relationship between resource availability, relative risks, and health status is critical for nurses to diagnose and treat health-related problems in this vulnerable population. (PubMed)
Poor health is both a cause and a result of homelessness. The National
Health Care for the Homeless Council (2008) estimates that 70% of
Health Care for the Homeless clients do not have health insurance. Moreover, approximately 14% of people treated by
homeless health care programs are children under the age of 15
(National Health Care for the Homeless Council, 2008).
Based on new evidence about increased poverty and future economic trends, there will be an increase in the next three years. homelessness in the United States could increase by 5 percent, or 74,000 people. The lingering effects of the recession have pushed more and more
Americans into precarious financial situations. Perhaps the most ominous indicator with respect to homelessness is the continuing rise in deep poverty, which increased to a record level of 20.5 million people in
2010. This marks the fourth consecutive annual increase in deep poverty and raises the deep poverty rate to 6.7 percent.
(Census Bureau 2011) This study is based on the homeless people living in shelters, a friends house, group homes, and living with family members because of an unstable place to live. This does not include all of the homeless people who live on the streets who are unaccounted for.

Homeless patients are part of the vulnerable population with many health issues, and taking care of the homeless can be very challenging. Developing a multifactor understanding of the histories of people experiencing homelessness is particularly important for treatment, care, and prevention. When treating homeless patients, the primary care practitioner along with the nurse must consider many contextual risk factors associated with acute and chronic disease such as the patient's history of homelessness, current living conditions, access to healthcare, and past history of medical care. Some questions to ask the patients may include If the patient is staying in a shelter, a vehicle, on the street, or in any other unstable living situation. Be aware that some patients may be too embarrassed to admit that they are homeless or do not consider themselves homeless because they live with a family member or friend.
This Is why on admission Intake skills are very important. In Many hospitals they use tools that as series of questions to help you recognize if a patient is homeless. The Emergency room department are very experience with taking care of patients who are homeless. The most challenging part of the emergency room is finding follow up care for patient’s without health insurance or a way for the patient to find a way to pay for a prescription, Especially with the prescribing of antibiotics. Most of the time these types of patients have not seen a Medical Doctor in years not knowing how long they were walking around with certain diseases. Most of the time the medical team is overwhelmed with homeless patients who have many issues. We often wonder to ourselves, who will pay for their medication? Which physician can we send the patient that will not charge? Especially with newly diagnosed diabetic patients. How will they able to afford healthy foods? How will they check their blood sugar?

When dealing with the homeless patients we are sometimes biased, especially if the same homeless patient comes to the emergency room over and over again. We might think to ourselves “here we
go again or It must be cold outside”. We might not want to take care of a homeless patient because of the smell. I always here nurses and other medical staff say “ why don’t they get a job, or why don’t they go to a shelter”. The fact is that, we do not know the real reason why some homeless patients choose to live in the streets. We do not know their past, and we do not know what kind of life they have lived. We cannot judge. We can only try to put ourselves in there shoes.

Homeless patients report high level of barriers to needed care and use acute hospital-based care at high rates. This causes a vicious cycle of repeated trips to the emergency room and climbing medical costs.
Homeless patients face numerous barriers in receiving appropriate health care, and follow up care with treatment. Researches have documented that a homeless person have high rates of substance abuse, mental illness, and physical illness. When a homeless person is admitted to the hospital, they are in the hospital for a longer period of time compared to a patient who has insurance. Number one, the hospital cannot discharge a patient if they do not have a stable home to live in. If the patient is diagnosed with Chronic Kidney Disease, the social worker has to look for a dialysis facility which will take the patient without medical insurance, and a nephrologist that will follow up the patient for free. This is all challenging. Imagine how challenging it will be if the patient is a homeless immigrant patient. An undocumented patient is the hardest patient to place, because they do not have a social security number. Conclusion
Homeless patients are considered a part of the vulnerable population because of all the risk factors, and limited medical treatment. The homeless vulnerable population health care needs are due to the limited resources of obtaining adequate food and shelter. However, given the opportunity, homeless patients are willing to obtain health care for chronic conditions if they believe such care to be important.
While prior research has described homeless patients dependence on acute care, such as hospital-based services, the factors associated with utilization of health care in this population have not been explored from a national perspective. Most research has focused on homeless persons residing in specific cities. Wide variations in characteristics and utilization patterns between different regions make national policy implications difficult to discern from local studies. Homelessness has proven to be a durable problem in diverse regions of the country, creating a large toll of human suffering as well as a complex burden on the safety-net health care system. National policy decisions geared toward decreasing barriers to appropriate health care utilization are needed. References

Adam D. Koon, MPH, Vivek S. Kantayya, MD, FAAFP, Bechara choucair, MD (University of phoenix library)

Homelessness, Health Status, and Health Care Use by Schanzer, Bella; Dominguez, Boanerges; Shrout, Patrick E; Caton, Carol L.M (University Of Phoenix Library)

Colwill, Jack M. Health Affairs29. 5 (May 2010) (University of Phoenix)

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