Transcript Caring for the Homeless Population

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Taysha Demetro
Meghan Shenot
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* 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
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* 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.
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* 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?
* http://www.youtube.com/watch?v=PqnGlqHOr
SE&feature=related
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* 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)
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* 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)
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Questions to ask
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• What do you think caused it?
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• What’s the most important thing we can do to help you with your
problem?
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?
• 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?
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* 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
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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)
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It is important when
caring for homeless
patients to shift
your care.
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* 20% of homeless people maintain full-time or parttime 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)
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*“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)
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* 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
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The 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)
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* 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!
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*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)
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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.
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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.
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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.
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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?
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* 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.
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* 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)
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* Community Services of Stark County. (2008). Retrieved from:
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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