CARING FOR THE

HOMELESS
By Kaitlyn Baldwin and
Shumetria Cleveland
Ferris State University

Objectives
Homelessness
Definition and statistics
Attitudes and Stigmas

Ethical and Political Considerations

Health Disparities
Barriers to Healthcare

Outreach Programs
Governmental Organizations
Nongovernmental Organizations

Recommendations
Nursing Considerations
Transcultural Nursing Theory

Introduction

Homeless
Having no place
to live. Having no
home or
permanent place
of residence
(Merriam-Webster,
2014).

Homeless is not an illness. It is a way of life and it is a culture (Law

& John, 2012).
In the United States, on a single night in January 2013, 610,042
people were experiencing homelessness (National Alliance to End
Homelessness, 2014).
People who are homeless are often chronically ill, jobless or have
recently lost all financial resources. Long - term homeless people
may have lived in poverty for years with no home site (Crawley et.
al., 2012).
The educational level of this vulnerable population may vary
greatly, from less than an eighth grade education to doctoral degrees
(Crawley et. al., 2012).
Unequal access to health care and insurance coverage has notably
increased morbidity and mortality (Weber, Thompson, Schmiege,
Peifer, Farrell, 2012).
Homeless people suffer from multiple health problems at a far
higher rate than the general U.S. population, yet 55 percent have no
medical insurance (NCH, 2009).
The priority for people who are homeless is meeting the basic needs
food, water, and shelter. Care for the response to the mental
illness is secondary (Boyd, 2008).

Statistics

http://www.endhomelessness.org/library/entry/the-state-of-homelessness-2014

Root Cause Analysis

The causes of homelessness
Poverty
Disasters
Mental illness
Decline in Available
Public Assistance
Lack of Affordable
Health Care

Lack of affordable
Housing
Unemployment
Domestic violence
Chronic substance
abuse
Medical Crisis

Attitudes and Stigmas

Healthcare Providers

Homeless Population

The homeless are lazy

The homeless are unclean
The homeless are abusing drugs
and alcohol
The homeless are stealing my hard
earned pay check by using
community resources
The homeless are thieves
The homeless are dumpster divers
The homeless are uneducated
The homeless are ex-convicts
The homeless are beggars

I have no health care insurance I

cant afford to get health care
Doctors, Nurses and Social
workers have a bad attitude
towards me because I am
homeless
I am homeless and that makes me
unworthy of proper healthcare
Health care is less important than
food and water and shelter
I cant trust people in positions of
authority

Political and ethical

considerations

Ethics:
Beneficence: the ethical principle of doing good.
Nonmaleficence: the ethical principle of do no
harm.
Justice: an ethical principle stating that everyone
should be treated the same.

(Chitty & Black, 2011).

Advocate for:
Housing/shelter
Food vouchers
Free transportation
Access to health care
Expansion to Medicaid
Clinics
Substance abuse
Mental health
Preventative clinics

Inferences, Implications and Consequences

High risk for communicable diseases which may lead to an outbreak and
become serious public health problem.
Uninsured or underinsured causes delay in obtaining services and results in
higher cost interventions for health complications.
Homeless frequent the emergency department three to four more than general
population.
Hospital stay is much longer due to limited housing.
70 % of the homeless admitted to the hospital are discharged back onto the
streets instead of shelters.
Less preventive care.
No access dental care.
(USLM, 2009).

Health Disparities and Barriers to Healthcare

Lack of transportation
Literacy difficulties
Feelings of stigma
Difficulty keep appointments &
adhering to medical plans
Lack of preventive care
Multiple day-to- day stressors
disorganization
Immigration issues
Limited or a lack of access to
insurance
(Gerber, 2013).
(Crawley et. al., 2013)

Recommendations for safe and quality care of the Homeless

Improve the cultural competency of health care providers.

Increasing the early screening of homeless children for
special health care needs. (NCH, 2009).
Plan for the appropriate discharge for recuperation.
Provide education to prevent health problems and offer
resources.
Reach out to low income children in after school programs
and in community settings.
Volunteer at community sites such as soup kitchen, shelters,
and community centers.
Managing urgent care clinics to reduce hospital cost.
(Gerber, 2013).
Donate blankets, shoes, clothes and hygiene products to the
shelters and outreach resources.
Become apart or support professional organization to prevent
homelessness like: National Coalition for the Homeless,
National Alliance to End Homelessness, and National health
care for the Homeless Council.
Be part of the solution! Advocate! Give! and Volunteer!
YOUR HELP IS NEEDED!

Nursing Considerations
The use of Transcultural Nursing Theory
Provide care to the homeless patients
with in their own cultural context
Develop care plans that are adapted
to and realistic to the patients
lifestyle
Avoid invading the personal space of
a homeless patient allow for space
and privacy during direct care
Be sensitive to nutritional alterations
related to lack of cooking facilities or
deficits secondary to an addiction
Develop knowledge of the homeless culture, language, stressors, health literacy, dietary
practices, spirituality, socioeconomic factors
Be aware of your own personal bias and understand that a culturally aware nurse
doesnt fully understand anothers culture
Remember to assess and ask the patient what their health concerns are and let them be
the expert of their own care plan
(Law & John, 2012)

 State and Federal Programs:

Medicare, Medicaid, welfare, Head Start, Supplemental Security Income (SSI),
Food stamps and Social Security Disability Insurance, Veterans Affairs (VA) disability
benefits. Section 8 Housing: operated by the state and city, tenants that is responsible for
paying one third of the monthly income toward rent.
Mckinney-Vento Homeless Assistance Act:
a federal program provided funds for outpatient health services. Safe havens: a form of
supportive housing that serve the mentally ill. Shelter Plus Care Program: a continuum of
care program allow various housing choices.
U.S. Department of Agriculture
Shelter and the WIC programs
U. S. Department of Housing and Urban Development (HUD): finance permanent
supportive housing targeted for chronically homeless people.
Social service agencies offer:
emergency over night shelter, food, hygiene products clothing through, churches, the soup
kitchens, United Way and Salvation Army.
Rehabilitation and Education:
provides a bridge between institutional and community care for severely mentally Ill and
substance- abusing people.
Alcoholics Anonymous:
People who abuse substances or have a dual diagnosis. (Body, 2008).

Community Resources to Aid People Who are Homeless:

National Coalition for the Homeless
www.nationalhomeless.org
National alliance to End Homelessness
http://www.endhomelessness.org
National health Care for the Homeless Council:
http://nhchc.org
U.S. Department of Housing and Urban Development:
http:// portal.hud.gov.
The National Data Resource center on Homelessness and Mental Illness
www.nrchmi.com
VA Homeless Assistance Information
www.va.gov/homeless
National Alliance for the Mentally Ill
www.nami.org
National Coalition for the Homeless
www.nationalhomeless.org

Conclusion
In the United State, homelessness is a
multifaceted problem that needs to be address
by the national, state, and local government
agencies, and nongovernmental nonprofit
organizations. The circumstances a homeless
person face from day to day is something we all
could face because anyone can be vulnerable at
any given time in life depending on the
circumstances. The cost and lack of health care
insurance are the biggest barriers to health and
hospital care for the homeless. The Homeless
populations inability to carry out treatment
recommendations hinders health because
survival is their first priority. It is imperative
that healthcare professionals respect this
population and begin to converge on the needs
of this population at large.

References
th

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43(3), 33-38.

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