State of Homelessness · key points of the presentation. The participant/ learner will gain an understanding into the homeless population, the barriers they encounter, and their views

Homelessness

Image retrieved from Google

Kerri Souter

Nursing 450

What is Homeless(ness)?

Woollcott defines homelessness as “the lack of „secure‟ or

„permanent‟ accommodations” (2008).

The Department of Housing and Urban Development defines homeless as; “an individual who lacks a fixed, regular, and adequate nighttime residence; an individual who's primary nighttime residence is shelter, an institution that provides a

temporary residence for individuals intended to be institutionalized; or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings”

(2011).

Woollcott (2008) Sermons, M., Witte, P. (2011).

Objective #1

Objective #2

The participant/ learner

will be able to identify the risk factors, economic indicators, populations at risk for homelessness, and available resources.

Evaluation can be measured by verbalizing key points of the presentation.

The participant/ learner will gain an understanding into the homeless population, the barriers they encounter, and their views on health care.

Evaluation can be measured by an open discussion on points presented.

Objectives

Purpose

The purpose of this project is to help

educate and enlighten other health care

professionals on how to better care for and

assist this growing population.


T h e n a t i o n ’ s h o m e l e s s p o p u l a t i o n i n c r e a s e d b y a p p r o x i m a t e l y 2 0 , 0 0 0 p e o p l e f r o m 2 0 0 8 - 2 0 0 9 ( 3 % i n c r e a s e ) .

3 1 o f 5 0 s t a t e s a n d t h e D i s t r i c t o f C o l u m b i a - h a d i n c r e a s e s i n t h e i r h o m e l e s s c o u n t s b e t w e e n 2 0 0 8 - 2 0 0 9 .

A n e s t i m a t e d 6 5 6 , 1 2 9 p e o p l e e x p e r i e n c e h o m e l e s s n e s s i n t h e U n i t e d S t a t e s o n a g i v e n n i g h t ( T h i s t r a n s l a t e s t o a r a t e o f 2 1 h o m e l e s s p e o p l e / 1 0 , 0 0 0 p e o p l e i n t h e g e n e r a l p o p u l a t i o n ) .

Frightening U.S. Statistics 2008-2009

Sermons, M., Witte, P. (2011).

People experiencing homelessness by Subpopulation, 2008-2009


Economic Indicators

Homelessness is most often caused by

job loss and other economic factors. From 2008-2009 the number of

unemployed people in America increased by 60% from 8.9 million to 14.3 million.

Nearly three-quarters of all US households with incomes below the federal poverty line spend over 50% of monthly household income on rent.

Foreclosure affected nearly half a million more households in 2009 than in 2008, a 21% increase for a total of 2.8 million foreclosed units in 2009.


Risk Factors for Homelessness

Unemployment

Foreclosure

Doubled up housing

Housing cost burden

Lack of health insurance

Sermons, M. & Witte, P. (2011).

At Risk Populations

People living in doubled

up situations

People discharged from prison

Young adults aged out of foster care

Uninsured people.


Basic Needs Barriers

Safety

Person hygiene

Adequate nutrition

Adequate shelter

Adequate health care

Addiction management

Respect for human dignity

Living with out essential resources

Putting off health care until emergent situation

Mistrust of mainstream health services

Mental Illness Severe hardships Drug/ Alcohol Abuse Diverse and complex health

challenges = Increased mortality

Basic Needs & Barriers of the Homeless Population

Martins, 2008, p.425

Acute illness Chronic illness

Upper respiratory infections

Trauma

Parasites

Skin ailments

Lacerations, wounds, sprains, & fractures

Malnutrition and vitamin deficiencies

Frostbite and hypothermia

Hypertension Peripheral vascular disease Poor dentition Gastrointestinal disorders Neurological problems Tuberculosis Skin/ leg/ foot problems Vision impairment HIV/ AIDS Addiction

Health Risks of the homeless population

Martins, 2008, p.421

Federal support:

State support:

National Alliance to End Homelessness

Opening Doors (a national, cooperative, interagency approach to end homelessness.)

The Michigan Coalition Against Homelessness (MCAH)

1-800-A-SHELTER line

Call 211 for assistance

Support & Resources for the Homeless

Sermons, M., Witte, P. (2011). Michigan.gov (n.d.)

Available Resources (West Michigan)

Medication- Holland Free Health Clinic 616-392-3610 Local pharmacies with $4 list of medications Websites such as: needymeds.com, Rxassistance.org, Freemedicine.com Check with pharmaceutical company that manufactures specific medication Intercare pharmacy if a current patient Medical Care- Intercare 616-399-0200 Holland Community Health Center 616-394-3788 City on a Hill Health Clinic 616-748-6009 Ottawa County Health Department 616-396-5266 Housing and Rent- Ottawa County Department of Human Services 616-394-7200 Community Action Agency (Utilities) 616-394-4433 Community Action House 616-392-2368 Good Samaritan Ministries 616-392-7159

Available Resources (West MI) cont…

Food Assistance- Community Action House 616-392-2368 Community Kitchen 616-392-9345 His Harvest Stand 616-748-6060 Love Incorporated 616-662-3300 Department of Human Services (food stamps) 616-394-7200 Beacon of Hope 616-396-4956 Emergency Shelter- Holland Rescue Mission 616-396-2200 Center for Women in Transition 616-392-2829 or 269-673-2299 (Allegan) Sylvia‟s Place 269-673-8700 Mel Trotter 616-454-8249

Homeless assistance systems


•Roughly 4 in 10 homeless people are found to be unsheltered on the streets or in other places not meant for human habitation.

•Unsheltered homeless people are often more vulnerable to i l lness, drug abuse, and violence than their sheltered counterparts.

Unsheltered Homeless



Maslow's Hierarchy of Needs

Rotter’s Social Learning Theory

Homeless individuals expend tremendous energy on survival strategies such as obtaining food, shelter and a place to rest. Only after these basic human needs are satisfied are they able to focus on their other health issues.

Julian Rotter introduced the ideas of learning from generalized expectancies of reinforcement and internal/ external locus of control (self-initiated change versus change influenced by others).

According to Rotter, health outcomes could be improved by the development of a sense of personal control over one's life.

Theories relating to homelessness

Nickasch & Marnocha (2009) Social cognitive theory (n.d.)

Fishbone Diagram for homelessness

Videos

h t t p : / / w w w . y o u t u b e . c o m / w a t c h ? v = o _ x J m Q C P J p Y

h t t p : / / w w w . y o u t u b e . c o m / w a t c h ? v = s h i X C C 9 C a P 4

Optional video

http://www.youtube.com/watch?v=5TelyWI6oko

Video‟s retrieved from YouTube

http://www.youtube.com/watch?v=o_xJmQCPJpY

http://www.youtube.com/watch?v=shiXCC9CaP4

http://www.youtube.com/watch?v=5TelyWI6oko

Recognize the patient or designee as the source of control and ful l partner in

providing compassionate and coordinated care based on respect for patient 's

preferences, values, and needs.

Quality and Safety Education for Nurses (QSEN)

Knowledge, Skills, and Attitude (KSA)

(QSEN, patient centered care, n.d.)

Patient Centered Care

Goals for Nurses

• Identify and address both physical

and emotional needs.

• Prioritize clients’ needs.

• Be honest.

• Listen to their story.

• Don’t judge on past experiences.

• Build trust.

• Gentle persuasion and respectful confrontation will help clients to consider treatments.

• Engage clients to identify barriers and compliance to treatment.

(Guirguis-Younger, McNeil, & Runnels, 2009)


Scope & Standards of Practice

Assessment: The registered nurse collects comprehensive data pertinent to the patient‟s health or the situation. Collect all relevant data in order to establish basic needs. Involve the patient, family and

other disciplines with the goal of providing holistic care.

Diagnosis: The registered nurse analyzes the assessment data to determine the diagnoses or issues. Analyzes holistic assessment data to determine issues and concerns.

Outcome Identification: The registered nurse identifies expected outcomes for a plan individualized to the patient or the situation. Identify expected outcomes with consideration for: risks, benefits, costs, best practices,

and clinical expertise.

ANA Scope and Standards of Practice, 2004

Scope and Standards of Practice cont…

Planning: The registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes. Develop a plan that considers the patients characteristics or situation,

keeping in mind environmental sensitivities and cultural differences.

Implementation: The registered nurse implements the identified plan. Establish a plan that utilizes evidence-based intervention and community

resources in order to implement the plan.

Ethical Considerations

“Healthcare providers must remember that all individuals deserve basic health care”

(p.45).

“Accepting individuals for who they are with openness and genuineness (Carl Rogers, Client Centered Therapy, 1951) is a core

nursing value” (p.46).

Nickasch & Marnocha (2009)

RCA (Root Cause Analysis) Case study

A 41 year old, unemployed, homeless man was admitted to the intensive care unit

from the emergency room with a diagnosis of altered level of consciousness,

pneumonia and elevated Troponin. He resided at the local mission and had

insurance. He was 6’4” tall and >320 pounds and had a history of mental illness,

depression, hypertension, elevated cholesterol, diabetes, dizziness, and falls.

Testing included; labs, x-rays, cat scans, physical therapy and glucose monitoring.

He was admitted by a Hospitalist, who ordered Cardiology, Neurology, and Psych

consults. After the Cardiologist consult and the patient’s Troponin level had

normalized , he was transferred to a medical-surgical unit. The Neurologist

recommended a MRI to rule out Multiple Sclerosis as an outpatient. He was too

large fit in our MRI machine because his shoulders were over 60 inches. The test

was rescheduled for him at Spectrum as an outpatient. The neurologist did not

find anything significant with his assessment and because of his continued

dizziness changed his current Antivert medication order to around the clock and as

needed. The Neurologist cleared this patient from his standpoint to be discharged.

Case Study Continued….

The patient’s assessment: His gait was unsteady as he was using an assistive device

(wheeled walker) and subsequently a stand by assist for ambulation. He continued to

have delayed response to questions and had a flat affect.

The Care Manager was working on discharge planning and was getting nowhere due to

a lack of resources. The patient did not have any family willing to assist him at

discharge due to: extenuating circumstances, legal reasons (his soon to be ex-wife had a

restraining order against him for domestic violence) ,“burnt bridges”, and family

members feeling like they were enabling him. He was unable to care for himself and

could not go back to the mission. The mission does not assist with ADL’s (activities of

daily living). There was one nursing home with an available bed left, but refused to

take him as an admission. There was talk of the nursing home “not wanting to get

stuck with him.” I am not sure if this was actually the case or if he didn’t meet criteria

for admission. Community Mental Health came in and evaluated him for admission to

a local crisis center. Because he had an extensive psychiatric history, and with his

current mental state, he fit criteria for admission to this crisis center. He was

transferred to the care of the crisis center.

Thoughts to ponder...

What if the crisis center would not have taken this patient? Who

would have cared for him? How can a homeless person pay for his needed medications? Where

could he patient keep his medications safe? What if the medication needed to be refrigerated? What if electricity was needed for medical equipment?

How would a homeless person call for an appointment if he had a Primary Care Provider (PCP)? How could the office contact this person if needed with no address or phone number? How would he get to the appointment?

Is it society‟s responsibility to care for this population?

How can health care providers improve their ability to care for

this growing population given the country's current

unemployment rate and economic status?

Question

"What we would like to do is change the world-make it a little simpler for people to feed, clothe, and shelter themselves as God

intended for them to do.” -- Dorothy Day

“They may forget your name but they will never forget how you made them feel.” --

Maya Angelou

Quotes

Retrieved from www.nursingschool.net

References:

American Nurses Association. (2004). Scope & Standards of Practice (p.21-31)

Daiski,I. (2007). Perspectives of Homeless People on Their Health and Health Needs Priorities.

Journal of Advanced Nursing, 58(3), 273-281. doi:10.1111/j.1365-2648.2007.04234.x

Daiski, I. (2009). Research Snapshot- How do the homeless see their own health? [video file]. Retrieved from http://www.youtube.com/watch?v=o_xJmQCPJpY

Fiscella, K., Shin,P. (2005). The Inverse Care Law. Implications for Healthcare of Vulnerable

Populations. Journal of Ambulatory Care Management, 28(4), 304-312.

Guirguis-Younger, M., McNeil, R., & Runnels, V. (2009). Learning and Knowledge-Integration

Strategies of Nurses and Client Care Workers Serving Homeless Persons. Canadian

Journal of Nursing Research, 41(2), 20-34.

HowToFixABrokenHeart. (2009). Homelessness in America [Video file]. Retrieved from http://www.youtube.com/watch?v=5TelyWI6oko

Martins, D. (2008). Experiences of Homeless People in the Health Care Delivery System: A

Descriptive Phenomenological Study. Public Health Nursing, 25(5), 420-430. doi:

10.1111/j.1525-1446.2008/00726.x

http://www.youtube.com/watch?v=o_xJmQCPJpY

References continued:

Nickasch,B., & Marnocha,S. (2009). Health Care Experiences of the Homeless. Journal of the American

Academy of Nurse Practitioners, 21, 39-46. doi: 10.1111/j.1745-7599.2008.00371.x

Pauly, B. (2008). Shifting Moral Values to Enhance Access to Health Care: Harm Reduction as a

Context for Ethical Nursing Practice. International Journal of Drug Policy, 19, 195-204.

doi:10.1016/j.drugpo.2008.02.009

Quality and Safety Education for Nurses. (n.d.). Patient Centered Care. Retrieved from:

www.qsen.org/ksas_prelicensure.php#patient-centered_care

Quotes (n.d.). Retrieved from: www.nursingschools.net/blog/2010/06/100-entertaining- inspiring- quotes-for-nurses/

Social Cognitive Theory. (n.d.). Retrieved from

www.infosihat.gov.my/.../HETheory/Social%20Cognitive%20Theory.doc

Sermons, M., White,P. (2011). State of Homelessness in America. A Research Report on Homelessness.

National Alliance to end Homelessness. Retrieved from www.endhomelessness.org

State of Michigan. (n.d.).Support for the Homeless. Retrieved from www.michigan.gov

DCTVNY. (2007). Voices of the Homeless. [Video file]. Retrieved from

www.youtube.com/watch?v=shiXCC9CaP4

http://www.nursingschools.net/blog/2010/06/100-entertaining-inspiring-quotes-for-nurses/

References continued:

Wiersma,p., Epperson, S., Terp, S., LaCourse, S., Flinton, B., Drenzek, C., Arnold, K., & Finelli, L.

(2007). Episodic Illness, Chronic Disease, and Health Care use Among Homeless Persons in

Metropolitan Atlanta, Georgia, 2007. Southern Medical Association,103(1),18-24.

Woollcott, M. (2008). Access to Primary Care Services for Homeless Mentally Ill People. Nursing

Standard, 22(35), 40-44.

Zlotnick, C., Zerger, S. (2008). Survey Findings on Characteristics and Health Status of Clients Treated

by the Federally Funded (US) Health Care for the Homeless Programs. Health and Social

Care in the Community, 17(1), 18-26. doi:10.111/j/1365-2523.2008.00793.x

Documents

State of Homelessness · key points of the presentation. The participant/ learner will gain an understanding into the homeless population, the barriers they encounter, and their views