Healthcare and the Homeless Presentation by: Timothy Amborski Ashley DenHartigh

Learner Objectives Identify who are the Homeless What are Barriers to obtaining healthcare Comorbidities of the Homeless Health care reform and the Homeless

Introduction “In 2011, about 636,000 people, more men than women, were homeless in the United States, a decrease of 1% from 2009” (Gerber, 2013, p. 34). “Over the last decade, the number of homeless families, many headed by single mothers in their 20s, has increased significantly. Many of these women have left a domestic situation because of physical and/or mental abuse” (Gerber, 2013, p. 34). “In 2013 on a given night, 610,000 people were experiencing homelessness in the United States. Around 92,000 are single adults viewed as chronically homeless, meaning they have a disability and history of long or frequent episodes of homelessness” ("Ending Homelessness," 2013, p. 1).

Introduction Continued “Research shows that people experiencing chronic homelessness are extremely poor and vulnerable, with complex medical, mental health and substance use conditions” ("Ending Homelessness," 2013, p. 1). “Despite their severe situations, many chronically homeless people are unable for various reasons to access disability programs such as Supplemental Security Income and Medicaid long-term services and supports. Without any resources, especially health care coverage, they frequently delay seeking care until they are very ill” ("Ending Homelessness," 2013, p. 1-2).

Risks Factors and Barriers “The homeless have various individual characteristics that may prevent their access to primary care services” (Riley, Harding, Underwood, & Carter, 2003, p. 475). “The social isolation and transience of some of those people registered by local authorities as homeless makes the provision of primary care to them problematic” (Riley, Harding, Underwood, & Carter, 2003, p. 475). “Some homeless people may be suspicious of traditional medical services and conventional health care” (Riley, Harding, Underwood, & Carter, 2003, p. 475).

Risk Factors and Barriers “The persistently homeless live in constant chaos, confusion, and fear. Trauma from head injuries, gunshot wounds, stab wounds, lacerations, and/or fractures is a significant cause of death and disability” (Gerber, 2013, p. 34). “Homeless people also experience higher rates of chronic disease, comorbidities, and physical limitations than the general population” (Gerber, 2013, p. 34). With health care reform many local free clinics are closing (including the one at my hospital). “Without any resources, especially health care coverage, they frequently delay seeking care until they are very ill. As a result, people experiencing chronic homeless are heavy users of costly emergency services and hospital care” ("Ending Homelessness," 2013, p. 2).

Fish Bone Diagram

Root Cause Analysis Problem: Homeless population with out access to Health care. Solution: “Medicaid expansion under the ACA has implications for ending chronic homelessness on two levels. First, it provides a core set of benefits – including behavioral health coverage – to individuals who have long been excluded from health care insurance. With full state participation, Medicaid would cover up to 16 million more people who are now uninsured” ("Ending Homelessness," 2013, p. 2). “Second, coverage for the expanding eligibility group means an influx of Medicaid dollars to local service systems, creating strategic opportunities to reset state and local safety-net funding priorities”("Ending Homelessness," 2013, p. 3).

Root Cause Analysis Continued Problem : Homeless without access to Primary Care Solution: With the American Health Act Primary care can be set up with the homeless when they apply for Medicaid. Outreach programs to get the homeless sign up for insurance must go out to the shelters and streets to guide this population.

References Gerber, L. (2013, March). Bringing home effective nursing care for the homeless [Magazine]. Nursing 2014, 43(3), 32-38. http://dx.doi.org/10.1097/01.NURSE.0000426620.51507.0c FOR PERMANENT SUPPORTIVE HOUSING CAPACITY. (2013). Retrieved from http://b.3cdn.net/naeh/e7ab3a008595ee9227_tnm6b1ukp.pdf Riley, A. J., Harding, G., Underwood, M. R., & Carter, Y. H. (2003, June). Homelessness: a problem for primary care? [Magazine]. British Journal of General Practice, 473-479. Retrieved from http://0- www.ncbi.nlm.nih.gov.libcat.ferris.edu/pmc/articles/PMC131462 3/pdf/12939894.pdf