Vulnerable Population Category: Medical and Social Services Help for Homeless

The most vulnerable population that comes to mind as a health care worker, would have to be those individuals who are homeless. According to the National Health Care for Homeless Council, the term homeless refers to the lack of fixed, regular, adequate nighttime residence (2017). When one is homeless, they are placed into the vulnerable population category because they lack the necessities to survive and live a productive life. This group of people often lack proper health maintenance including the innate human need for adequate nutrition. A lot of their issues and poor health are related solely on their financial instability. People do not tend to want to be homeless. There are a lot of factors that contribute to one’s downfall. Many homeless individuals battle with addiction to drugs and alcohol. A large group of this population suffer from Schizophrenia well as many other mental health issues. (NAEH, 2016). There are also many social factors including natural disasters, loss of employment leading to personal and financial crisis, domestic violence and the result of poverty. These individuals have many reasons as to how they got in “a tough spot”. I think health care workers could help shine a light for people in their darkest of times.

Homelessness can happen to anyone regardless of gender, age, race, or sexual orientation. Youth are considered homeless if they are under the age of 18 living without a parental figure or institutional care. Over 40,000 veterans are homeless (Shane, 2017). More men are likely to be homeless than women. According to the National Coalition for the Homeless (2009) 20-25% of homeless individuals suffer from some form of severe mental illness. Meaning these individuals are seriously lacking proper health care. Our society does not express any favor for homeless individuals. I think many find it hard to interact with this group mainly based on fear. Fear of mental instability and/or fear of the homeless unkept appearance. All to often does one hear, “Look at that bum! Why doesn’t he just get up and find a job instead of waiting for handouts. ” Most people do not try and consider underlying cause of a person being homeless and ever fewer attempt to help or even acknowledge the issue of a human being living on the streets without proper shelter and food. Due to a lack in health care maintenance, the homeless population suffers from many manageable conditions, in sever forms. Common health issues found in this group are untreated HIV and AIDS, tuberculosis, Hepatitis C, diabetes, hypertension, and unmedicated mental disorders (United States Interagency Council on Homelessness, 2017). Since these individuals do not seek proper health care, TB runs rampart in the homeless community; in part due to close living conditions as well as lack of education about disease process. Another issue found, is that homeless individuals often share utensils and modes of drug paraphernalia. Leading to a high case of IV drug related transmitted illnesses. Many of these individuals do not know that they can exchange used needles for clean ones simply by calling The North American Syringe Exchange Network at 253-272-4857.

The homeless population is also at risk for criminal victimization and therefore are at an increased risk for trauma on top of a poor health outlook. This susceptible group faces many environmental health issues; including harsh living conditions, exposure to natural disasters, as well as environmental hazards like low air quality and excess radiation. These individuals often lack proper clothing for the changing of seasons, leading to more illnesses like the flu and pneumonia. Homeless people lack proper nutrition and often times report going several days without a meal. Desperation leads many to look in garbage cans for food, opening the way for food borne illnesses and parasites. While there are some shelters available, not everyone has the means to get to one. Also, they tend to close their doors early leaving many out in the environment for the night. Those that are lucky enough to get into the shelter are at risk for becoming violence victims; often times, people are rapped or robbed inside of shelters (Foster, 2016). Fear of shelters leads many to just sleep outside under a bridge or on a park bench exposing them to the elements of nature and wild animals. Proper access to healthcare is extremely challenging for destitute individuals. With health care reform being ever changing, people with little to no income are finding it more and more difficult to get health insurance. When considering that these people cannot even afford to have their next meal, how does one expect them to afford health care coverage? This leaves homeless individuals limited to the health department, which all too often is overcrowded, or free health care clinics which are only open for a short window during the day. This population usually relies sole on walking to get from place to place. Making it hard to travel for health care. Most of this group stays in the inner city near large hospitals. When they are sick enough they often come into the ER for treatment and a warm bed. In the winter there is often an increase of homeless individuals at the hospital, just as a means of food and shelter for the night.

Which can take up valuable resources for those who truly need immediate medical attention. This group would benefit from and have more success with a program that is integrated with housing assistance (United States Interagency Council on Homelessness, 2017). A stable means of shelter provides a platform for consistency allowing for better maintenance of health and well-being. Nurses should consider many different angles when caring for the homeless population. One major aspect would be to determine if this person has any personal beliefs and try and be courteous of them. One should try to illuminate any mental disorders or addictions that the patient may be afflicted with. Understanding the state of mind, one’s patient is in allows for proper empathy and holistic approach to health care. The nurse must eliminate one’s own beliefs about homeless individuals and focus on the real live person who needs their care. Often times these individuals have had unpleasant interactions with other. This means that trust plays a major factor in building proper rapport with this patient. Always follow up with what you tell you patient and stick to your promises. When dealing with a patient with mental illnesses, one must understand that often time that person does not comprehend that their actions play a role in their health and situation. A nurse must also keep in mind that this population is often under educated and have no guidance even when discussing small topics such as proper hygiene. This population would benefit from multiple teachings and adequate time for teach back (where patient shows the skill and not just talking about it. )

The nurse should also set up a case manager for this patient. Case management nurses can be valuable assets when it comes to finding shelters, soup kitchens, clinics, and social service agencies. There are many opportunities for nurses to help homeless patients. Preventative measures are the biggest thing a nurse can teach anyone. For this specific group, the nurse should consider primary prevention factors such as the basic need of proper hygiene techniques. This group needs to be up to date on vaccinations to help stop the spread of preventable diseases like the flu or pneumonia. They need access to social services that offer help with mental disorders, rehab for addiction, financial counseling, housing assistance, behavioral management, and even parenting skills for the homeless parents. When a nurse understands that this patient population lacks many of the basic amenities, they understand it can be difficult to prevent illnesses and therefore we must educate and provide resources to continue to help our patient even after they leave our care. Secondary prevention interventions would include screening for diseases and illnesses, as well as barriers to accessing services for healthcare and housing. Tertiary prevention interventions would include the treatment of secondary illnesses related to advanced diseases and providing the means for rehabilitation care. These patients will need a lot of outpatient support as they often lack family support. Having a social worker can really help changes these individuals lives.