| Homelessness as a Public Health Issue |
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| Written by NurseKeith | |
| Sunday, 15 June 2008 | |
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Homelessness is a public health and economic justice issue that all nurses should bear in mind when assessing patients. As front-line healthcare providers, it is often up to nurses to elicit crucial information about a patient's living situation. Homelessness is pervasive throughout the United States, from small towns and rural areas to the country’s largest and most populous cities. The homeless---and those at high risk of homelessness---do not necessarily meet the stereotypical description so often used by the American media. Rather than simply being unkempt men and women sleeping on cardboard over urban heating grates (an apt yet very limited description of a very small percentage of the homeless), children figure greatly in the American homeless story. With the recent meteoric increase in mortgage foreclosures across the country, more and more families are at risk, as are military veterans, recently released prisoners, and teenagers. As nurses, we must be aware of the plight of the homeless as both healthcare providers and as citizens, and we must be prepared to assist our patients to access services to prevent---or end---both chronic and emergent homelessness. Information available on the National Health Care for the Homeless Council website elucidates that homelessness and poor health are “locked in an ongoing cycle of cause and effect”. First of all, ill health puts one at greater risk of homelessness, with half of all US bankruptcies being caused by the economic devastation of unexpected or chronic illness. Once an individual or family is homeless, poor nutrition, poor access to preventive healthcare, and exposure to the elements and communicable diseases all pose major threats to health. With poor hygiene and sanitation, and the risk of addiction, violence and injury, the homeless individuals’ life expectancy decreases, and his or her cost to society increases astronomically. Based on recent data from the website of the National Alliance to End Homelessness , 650,000 former prisoners are released from jail to potential homelessness each year. In terms of families, 600,000 families---including 1.35 million children---face homelessness every year in the United States, most likely due to the rising cost of housing in relation to income. Additionally, at any given time, more than 200,000 military veterans are chronically homeless---often with untreated PTSD, addiction, and mental illness---after having served our country at home and abroad. Beyond Shelter , an organization based in Los Angeles, cites high rates of domestic violence, welfare reform, the increase in low-wage jobs, and the decreased availability of affordable family housing as major sources of the increase in homelessness being seen throughout the United States. According to an article published on Forbes.com , the estimated cost of housing a homeless person for one year is approximately $12,500, a figure that other studies place at approximately $16,000 annually. The article cites further data that the chronically homeless in the United States cost this country approximately $10.95 billion in public funds, taking into account emergency room visits, jail time, and shelter costs. Data show that if these individuals were permanently and safely housed, those costs would decrease by more than $3 billion per year. Studies have shown time and again that providing permanent housing without mandatory sobriety requirements decreases emergency room use, increases lifestyle stability, and most notably, increases housed individuals’ openness to receiving other services such as detoxification, counseling, and job training. The Housing First movement is attempting to counteract these numbers by propagating the notion that providing quality permanent housing is the answer to our growing population of homeless individuals and families, and their website offers a great deal of food for thought supported by a well-documented methodology. Nurses on the front lines Groups of nurses across the country provide grant-funded and institutionally supported homeless outreach programs in concerted attempts to reach those vulnerable individuals who already live on the street. Each winter, the media in numerous communities around the country will tell the story of homeless individuals who have frozen to death on cold winter nights. The nurses who perform such homeless outreach are certainly doing an important part of the work, but there is still a great deal that can be done beyond such direct outreach. For the majority of us who do not work in homeless outreach programs, there is still a vital role for us to play. Nurses are often the first members of the healthcare team with whom homeless individuals---or those at risk of homelessness---will interact. Performing triage in an emergency room, screening patients in a clinic, assessing patients on home visits, or preparing a patient for hospital discharge---these are all scenarios in which we can actively attempt to ascertain a patient’s housing status using our skills of assessment and interviewing. While we would like to think that every patient we see is securely housed and able to put food on the table, part of our psychosocial assessment must include questions regarding housing and nutritional/economic status, no matter how uncomfortable that may be. Some facilities may actually provide assessment documents that guide the nurse through such lines of questioning, but all too often we will find that healthcare institutions ignore or overlook these concerns, perhaps in the interest of brevity and productivity. As the members of the healthcare team who often perform the most comprehensive screenings of patients, it is up to nurses to identify those at risk of homelessness, as well as those who may already be homeless. Once identified, these individuals must be referred for appropriate services so that they do not fall through the ever-widening cracks that exist in almost every cash-strapped area of social and human service in this country. For homeless individuals, referrals to soup kitchens, food pantries, homeless outreach programs, emergency shelters, and housing advocates should be the first steps in providing initial referrals. In some cities, organizations such as the local United Way, YMCA, and YWCA can provide leads and referrals, and grant-funded or municipal housing organizations will often have access to Single Room Occupancy (SRO) sites where homeless individuals can obtain transitional housing. You can also contact the U.S. Department of Housing and Urban Development (HUD) for resources, or visit websites such as The Homelessness Resource Center for information and training on the dual problems of homelessness and addiction. Information is key Nurses are holders of key information in a wide variety of areas, and as such, nurses are responsible to impart that information to those who would benefit from it. With training in critical thinking and cross-specialty collaboration, nurses are also adept at assessing clients, ascertaining areas of need, creating a plan of care, and then actualizing that plan of care through a deliberate course of action. The assessment of patients’ housing needs is one part of a thorough psychosocial evaluation, and nurses can often serve as the crucial professionals who assist individuals and families in breaking a cycle of homelessness or near-homelessness. In whatever position you hold as a nurse, make it a point to somehow ascertain your clients’ housing status in the course of your assessments, and periodically check on the stability of patients who you see over long periods of time, since housing status is often a fluctuating state. Also, consider creating a computer file or actual paper file of housing resources for your region, or contact a colleague at a local housing advocacy organization and exchange business cards for future reference. As nurses, housing is not usually the first thing on our minds when we evaluate a patient. However, along with nutritional status, demographics, a physical assessment and a plan of care, housing status is a crucial aspect of patients’ lives that should never be overlooked. Consider incorporating this information into your nursing practice, and perhaps some day a patient in need of housing assistance will have you to thank for assisting in alleviating what can be a devastating problem of both personal---and public---health. --------
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  written by a guest, June 16, 2008
I wonder how many are homeless because they can't find safe housing when they have chemical sensitivities? Trying to avoid things like pesticides, perfumes, VOC's from dryer vents, "air-fresheners, smoke, and other things people put in the air we all share, isn't an easy task, no matter how much money one has for housing. There are currently no supports to help people with this, nor are there many hospital or medical facilities with "clean rooms" to help. Do you know of any efforts being made to address this issue?
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There is no support for people with MCS on any official level, although the ADA deems MCS an official disability. However, with the medical community's stonewalling, how much bite can the ADA have in such matters?
There are informal supports for people with MCS and many websites offering help, not to mention several groups trying to build intentional communities specifically for people with chemical sensitivity.
My wife and I both have MCS to different degrees, and while our symptoms are mild, a potential move to another part of the country is a very thorny issue due to the difficulty in trying to find housing that is relatively safe.
There is a filmmaker trying to finish a film on the subject of safe housing for people with MCS. However, I do not recommend the Hollywood movie "Safe" with Julianne Moore, which apparently does a terrible job of telling a fictional story about a very real problem.