1. Mellanie Hopkins March 9, 2010

2. Lack a regular and adequate nighttime residence or… Have a primary nighttime residence that is A supervised shelter An institution that provides a temporary residence to people that are intended to be institutionalized A public or private place not designed for regular sleeping accommodations (Martins, 2008).

3. More people living in poverty Decrease in affordable housing Loss of single room occupancy buildings Emergency demands on income Alcohol and drug addiction Limited transitional treatment facilities for deinstitutionalized mentally ill people (Stanhope & Lancaster, 2006).

4. http://www.youtube.com/watch?v=EDQA2yCQkC4&f eature=related http://www.youtube.com/watch?v=EDQA2yCQkC4&f eature=related (Health This Week, 2009)

5. 3.5 million people are homeless over the course of a year. Half are families with children. 20% maintain full or part-time jobs. 23% of homeless are veterans 50% of homeless women and children become homeless as a result of domestic violence.

6. 3% report having HIV/AIDS 26% report acute health problems such as TB, pneumonia, or sexually transmitted diseases 16% of single adult homeless population have serious mental illness (Stanhope & Lancaster, 2006). Homeless adults have a mortality rate 4 times that of the general population. Average life span of a homeless person=45 years (CDC, 2010).

7. Infestations and skin ailments PVD and hypertension Diabetes and malnutrition Respiratory infections and COPD Trauma Mental illness Substance abuse Communicable diseases TB, HIV/AIDS, STDs (Stanhope & Lancaster, 2006).

8. Increase proportion of people with health insurance. Increase proportion of people who have a specific source of ongoing care. Reduce the number of families that experience difficulties or delays in obtaining health care. Reduce the number of homeless adults who have serious mental illness to 19% from 25%. Increase employment of people with serious mental illness from 43% to 51%. Increase the number of states from 24 to 50 that have screening, crisis intervention, and treatment services for older adults (Stanhope & Lancaster, 2006).

9. Homeless use tremendous energy on obtaining food, shelter, and a place to rest (Nickasch & Marnocha, 2009). Implement neighborhood education and interventions that promote health among people most at risk of becoming homeless (Schanzer, Cominguez, Shrout & Caton, 2007).

10. Homelessness is associated with numerous risks that expose people to communicable infections which may spread among the homeless and lead to serious public health concerns (Badiaga, Raoult & Brouqui, 2008). For the homeless, health care is crisis oriented and usually found in emergency departments (Stanhope & Lancaster, 2006).

11. Vaccination against hepatitis B virus, hepatitis A virus, influenza, Streptococcus pneumoniae, and diptheria Distribution of free condoms. Improvement of clothing and bedding hygiene. Provide disease prevention education in areas heavily populated with homeless (Badiaga, Raoult & Brouqui, 2008).

12. Screening for TB in shelters. Mental health screening in shelters and homeless areas. Use of ivermectin for scabies and body lice. Scabies and body lice infestations lead to pruritus which may result in bacterial superinfections (Badiaga, Raoult & Brouqui, 2008).

13. Providing services and treatment directly to the homeless individual’s location (Drury, 2008). Provide access to medication in homeless neighborhoods for patients requiring consistent pharmacological treatments.

14. Social triaging Instead of being triaged by health care needs, homeless may be triaged according to the ability to pay. No system in place for health care of the homeless Being labeled and stigmatized Being treated with disrespect Homeless feel invisible to health care providers (Martins, 2008).

15. Patients who have no place to rest, bathe, cook, or store medicine require creative care planning. Tailor education to targeted populations focused in areas where homeless reside. Draw on a person’s strengths and inner resources. Emphasize full participation by the individual (Billings & Kowalski, 2008).

16. Homeless individuals feel they are not in control of their health needs. Healthcare providers must be aware that basic physical needs must be met before trying to address health related concerns (Nickasch & Marnocha, 2009). Homeless people deserve respect while seeking health care. Nurses need to build on the strengths and inner resources of the homeless rather than try to overcome their problems (Martins, 2008).

17. Badiaga, S., Raoult, D., & Brouqui, P. (2008). Preventing and Controlling Emerging and Reemerging Transmissible Diseases in the Homeless. Emerging Infectious Diseases, 14(9), 1353-1359. doi:10.3201/eid1409.080204. CDC/National Center for Health Statistics. The Homeless. Center for Disease Control. Retrieved February 27, 2010, from http://www.cdcnpin.org/scripts/ population /homeless.asp. Drury, L. (2008). From homeless to housed: caring for people in transition. Journal Of Community Health Nursing, 25(2), 91-105. Retrieved from MEDLINE database.

18. Health This Week (2009, May 20). Health care for the homeless. (Video file). Video posted to http://www.youtube.com/watch?v=EDQA2yCQkC4&f eature=related. Martins, D. (2008). Experiences of Homeless People in the Health Care Delivery System: A Descriptive Phenomenological Study. Public Health Nursing, 25(5), 420-430. doi:10.1111/j.1525-1446.2008.00726.x. Nickasch, B., & Marnocha, S. (2009). Healthcare experiences of the homeless. Journal of the American Academy of Nurse Practitioners, 21(1), 39- 46. doi:10.1111/j.1745-7599.2008.00371.x.

19. Office of Disease Prevention and Health Promotion. Community Setting and Select Populations. Healthy People 2010. Retrieved February 22, 2010, from http://www.healthypeople.gov /Document/HTML/Volume1 /07Ed.htm#_Toc490550859. Schanzer, B., Dominguez, B., Shrout, P., & Caton, C. (2007). Homelessness, Health Status, and Health Care Use. American Journal of Public Health, 97(3), 464-469. doi:10.2105/AJPH.2005.076190. Stanhope, M. & Lancaster, J. (2006). Foundations of nursing in the community: Community-oriented practice (2 nd ed.) St. Louis: Mosby. Zrinyi, M., & Balogh, Z. (2004). Student Nurse Attitudes Towards Homeless Clients: A Challenge for Education and Practice. Nursing Ethics, 11(4), 334-348. doi:10.1191/0969733004ne707oa.