Taysha DemetroMeghan Shenot

*Caring for the Homeless Population

*Objectives*Reasons why people are homeless*How to assess (questions to ask)*Epidemiology (popular diseases/problems)*Healthy People 2020*Case Study/Critical Questions*Health Promotion and Prevention*Services within the community

*Behavioral Objectives

*1. The class will be able to demonstrate why Maslow's Hierarchy of Needs is so important when assessing the homeless population by the end of our presentation.

*2. The class will learn what necessary questions to ask the homeless in order to gather data to perform a complete head to toe assessment by the end of our presentation.

*3. The class will be able to identify places and resources that the homeless will be able to use by the end of our presentation.

*Critical Thinking Questions:

*1. When you see a homeless person, what do you think or do?

*2. If you were working in the ER and a homeless person came in, how would your assessment differ from that of another person?

*3. Now that you've assessed this homeless person, what would you do next?

Youtube clip

*http://www.youtube.com/watch?v=PqnGlqHOrSE&feature=related

*Reasons for Homelessness

*Mental illness*Unemployment and underemployment*Domestic violence/abuse*Abandonment*Natural disasters and fires*Substance abuse and addiction

*Trimorbidity- substance abuse addiction, mental illness, and another chronic condition ex- HTN *(Harkness & DeMarco, 2012)

*Reasons Continued*Children born to parents who are homeless

or who have become homeless because*eviction *overcrowding*conflict*natural disasters* (Harkness & DeMarco, 2012)*The homeless include single men, families

with children led by single heads of households (women) single women(bag ladies), and children(<18 years of age) who lack supervision. (Harkness & DeMarco, 2012)

*Assessment of the Homeless

* Questions to ask* Please help me understand why you are here at the hospital.* • What do you call the problem or sickness that brought you to

the hospital?* • What do you think caused it?* • Is it causing any other problems for you? If it is, please describe

them.* • Do you have any fears about this problem?* • Can you describe how you got it?* • Can you tell me anything about how it affects your health?* • Can you tell me what you think caused it?* • How bad do you think the problem is?* • How long do you think it will last?* • What do you think we can do to help you while you’re here at

the hospital?* • What’s the most important thing we can do to help you with

your problem?

*More Questions* Assessing the patient’s living situation and healthcare

resources* To evaluate a patient’s housing situation, ask:* • Where did you sleep last night?* • What’s your usual place for sleeping and eating?* • How long have you been without a place to live? (if the patient is

homeless)* • Who do you turn to when you need help?* To assess the patient’s access to healthcare resources, ask:* • Where do you buy and keep your pills?* • Where do you usually go when you don’t feel well?* • Do you have insurance to help you pay your medical bills? (Savage &

Lee, 2010)

* (Things to think about when planning discharge teaching-if patient going home on insulin, they can’t be discharged back to where they were living if they don’t have a refrigerator to store the insulin)

*Maslow’s Hierarchy of Needs

It is important when caring for homeless patients to shift your care.

*Epidemiology*20% of homeless people maintain full-time or

part-time jobs, but many lack health insurance*Homeless people do not receive care in chronic

illnesses such as hypertension, diabetes, heart disease and emphysema*They may deny health problems due to other

financial needs that they may find more important such as clothing, food and hygiene (Maslow)*Common medical conditions include skin

conditions (lice, scabies, eczema), respiratory infections, tooth decay, feet problems, STD’s and vision disturbances (Donohoe, 2004)

*Healthy People 2020

*“Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.*Achieve health equity, eliminate disparities, and improve the health of all groups.*Create social and physical environments that promote good health for all.*Promote quality of life, healthy development, and healthy behaviors across all life stages.” (Healthy People 2020, 2011)

*Health Promotion& Prevention*One important intervention to a homeless person

could be to simply provide them with information on the nearest shelter or soup kitchen *Interventions that should be aimed at homeless

people are disease preventions- remember knowledge is power*These interventions should include condom

distributions, vaccination programs, and screening clinics*Other health promotion activities can include

distributing sunblock or hats and information on how to avoid sunstroke and the distribution of laundry facilities and clean socks to care for feet and other general hygiene tips

*Community Health Nurse’s

RoleThe responsibility of the CHN:* an advocate for a patient’s health and wellness*Nurses have to be creative when planning interventions*Start with a family assessment*The ultimate goal should be to enable the family to identify its health needs and to help them choose the best way they can meet that need.*to eliminate disparities in healthcare delivery *Community Nurses are known to be resourceful *Sharing information about available agencies and related resources will help families meet their health goals*Internet or finding a clinic for a family who is in need*to promote health literacy *Providing information that is clear, concise, and understandable is essential – we have to be on their level(Harkness & DeMarco, 2012)

*Easy ways to help out

*Show respect*Use a positive approach- builds trust!*Support primary(advocacy), secondary

(TB screening), and tertiary (“detox” treatment) prevention to make it easier to cope with difficult, challenging lives.*(Harkness & DeMarco, 2012)* and don’t forget to live by the golden

rule– Treat others the way you want to be treated!

*Services within the community

*Community Services of Stark County provides temporary shelter programs for families within Stark county that are homeless

*They provide counseling, substance abuse education, case management, life and employability skills and case coordination

*They also provide assistance for people with AIDS, money management and basic computer literacy education (Community Services of Stark County, 2008)

*The YWCA is another homeless shelter that provides services all over Canton similar to the previous that include providing emergency shelter for up to 90 days, assisting in gaining education and skills and works with individuals with disabilities and in addition can provide clothing, food and hygiene and have laundry and a kitchen on site with social workers on staff (Housing Homeless Services, 2012)

*Case Study* Joe Seally, age 52, is an African-American who weighs 250 lb. He is admitted

to the med-surg unit for observation after presenting to the emergency department (ED) with dizziness, confusion, visual disturbances, frequent headaches, and (most recently) nausea and vomiting. His admitting blood pressure is 210/110 mm Hg. The physician starts him on a diuretic and a beta blocker.

* Based on information obtained from ED workers, the med-surg nurse suspects Mr. Seally may not have a regular place to live. She begins the assessment by asking if he’s homeless. He responds, “No.” When she follows up with, “Where did you sleep last night?”, he replies, “In a car.” To make sure she has the full picture, she asks, “Where do you usually sleep?” She learns he usually sleeps in an abandoned car, which he considers to be his home. During the behavioral assessment, she screens for substance use disorders and depression using commonly available tools.

* Physical assessment reveals Mr. Seally has a bad case of athlete’s foot and significant tooth loss. He admits he gets most of his food by rummaging through dumpsters behind restaurants. (The soup kitchen nearest to the car where he sleeps is too far away and he usually doesn’t feel up to the long walk.) When the nurse screens him for alcohol or drug use and depression, the results are negative.

* The nurse realizes that the usual discharge instructions on diet, exercise, and medications for hypertensive patients won’t be practical for Mr. Seally. He says he has no health insurance and no idea where to obtain medications, health supplies, or primary care. And because he lives in an abandoned car, the diuretic he’s been prescribed poses a unique problem: The frequent urination it causes could cause him to be arrested if he urinates in a public place.

* The discharge plan also must address other issues: With his food coming mainly from restaurant leftovers, can he maintain a low-sodium diet? Is he at risk for potassium depletion?

*Case Study (cont’d.)

* The nurse works with Mr. Seally, the physician, and the social worker to develop a discharge plan that takes into account his unique situation. The social worker finds a temporary shelter that provides access to public restrooms and a soup kitchen. She contacts the soup kitchen to find out about the usual menu, and shares this information with the patient, nurse, and nutritionist to aid dietary planning. Mr. Seally is referred to a free clinic for routine foot care and blood pressure checks, as well as an agency that can help him obtain medications and dental care.

* The compassionate approach taken by Mr. Seally’s nurse set the stage for a trusting relationship. Initial assessment provided the essential information on which to base a customized discharge plan. The nurse and other healthcare team members gave him hope and the tools he needs to manage his hypertension, decrease his need for readmission, and improve his ability to manage his hypertension after discharge.

*Other Resources

* Akron-Canton Regional Food Bank* Several churches in Canal Fulton, Massillon, Canton

and Alliance that provide food and/or clothing* Canton Health & Wellness Free Clinic* Western Stark Free Clinic in Massillon provides

medical, dental and pharmaceutical services that treat patients that are below the poverty level. They also have a mobile homeless program that drives to 16 homeless facilities throughout the county* Planned Parenthood (provides reproductive services

based on income)

*References* Community Services of Stark County. (2008). Retrieved from:

http://www.communityservicesofstark.org/programs.html* Donohoe, M. (2004). Homelessness in the United States: history,

epidemiology, health issues, women, and public policy. Medscape Ob/Gyn & Womens Health, 9(2). Retrieved from: http://www.medscape.com/viewarticle/481800

* Harkness, G., & DeMarco, R. (2012). Community and public health nursing: Evidence for practice. New York, NY: Wolters Kluwer Health.

* Healthy People 2020. (2011). U.S. Department of Health & Human Services. Retrieved from: http://www.healthypeople.gov/2020/about/default.aspx

* Housing Homeless Services. (2012). Canton YWCA. Retrieved from: http://www.ywcacanton.org/homelesshousing.aspx

* Savage, C., & Lee, R.L. (2010). Caring for a homeless adult with a chronic disease. American Nurses Today, 5(3). Retrieved from http://www.americannursetoday.com/article.aspx?id=6376&fid=6276