1. Health Care Disparities: Homeless Populations Jennifer Held, RN Christy Rapoza, RN

2. In 2014, The Department of Housing and Urban Development (HUD) released their Annual Homeless Assessment Report to Congress… 578,424 people were homeless in the US. 37% of those were homeless families 23% of those were under age 18 An estimated 12,227 people were homeless in Michigan From 2013 to 2014 their was a 6.1% or 700 people increase in the number of homeless people in Michigan

3. Relevance to Nursing The homeless population has higher rates of chronic disease. Homeless have many obstacles to treatment Maslow’s Hierarchy of Needs

4. Healthcare Environment: Systems Framework

5. Healthcare Environment: Underlying Assumptions Homeless population do not value their health They are lawbreakers They are alcohol and drug addicts They are mentally ill

6. Healthcare Environment: Root Cause Analysis Approximately 25% of the homeless population has a mental health illness (Gerber, 2013) 84% of men and 54% of homeless women have an alcohol use disorder (Gerber, 2013) Homeless population only focuses on the present.

7. Inferences and Implications Self fulfilling prophecies, help them break out of the homeless cycle. Homelessness will never improve until we improve approaches. Homeless can be a challenging population not matter the interventions.

8. Money talks Why do we need to spend more money on healthcare when the budget for homeless healthcare was effective in decreasing the homeless population? Are we addressing the root cause of homelessness?

9. Why homeless do not utilize healthcare? Professionals at times see homeless not caring and being very time consuming because of their complex health issues and non-compliance Professionals were often seen as offering unwanted labels and as being rule bound. Participants also expressed feeling trapped within the homeless system

10. Available Programs McKinney-Vento homeless assistance grant The Affordable housing and self- sufficiency Act of 2011 Homeless Empowerment Project

11. Recommendations for Nurses Familiarize yourself with available programs in the area to help homeless Present information in the present tense but also educate in the future tense. Make care plans, specific and obtainable for the homeless patients, utilizing only resources that are available to them.

12. Conclusion Health care for this population must be patient-centered. Often meeting their basic needs such as food, water, sleep, and shelter. Until these needs are met, their health is not as important. National Hunger and Homeless Awareness Week

13. References Belcher, J. & DeForge, B. (2012). Social Stigma and Homelessness: The limits of social change. Journal of Human Behavior in the Social Environment, 22 (8). Gerber, L. (2013,). Bringing home effective nursing care for the homeless. Nursing2015, 43(3), 32-38. Harkness, G. A., & DeMarco, R. F. (2012). Community and public health nursing: Evidence for practice. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins Law & John. (2012) Homelessness as culture: How transcultural nursing theory can assist caring for the homeless. Nurse Education in Practice, 12(6). National Alliance to End Homelessness. 2013. McKinney-Vento homeless assistance grants. Retrieved from http://www.endhomelessness.org/pages/mckinneyvento_HAG National Alliance to End Homelessness. 2013. Section 8 Voucher funding and reform. Retrieved from http://www.endhomelessness.org/pages/section_8 Ogden, J., & Avades, T. (2011). Being homeless and the use and nonuse of services: a qualitative study. Journal of Community Psychology, Volume 39, Issue 4, pages 499–505 National Coalition for the Homeless (NCH)(2011). Homeless Empowerment Project. Retrieved from http://www.nationalhomeless.org/faces/homelessempowermentproject.html The U.S. Department of Housing and Urban Development (October 2014). The 2014 Annual Homeless Assessment Report (AHAR)to Congress. Retrieved from https://www.hudexchange.info/resources/documents/2014-AHAR-Part1.pdf World Health Organization (WHO). (2013). The WHO Health Systems Framework. Retrieved from http://www.wpro.who.int/health_services/health_systems_framework/en/ United States Interagency Council on Homelessness (USICH)(2014), Proposed fiscal Year 2014 Budget Fact Sheet: Targeted Homelessness Assistance. Retrieved from http://usich.gov/resources/uploads/asset_library/FY14_Budget_Fact_Sheet.pdf..