Vulnerable Populations: Focusing on the Homeless - Essay Example

?Running head: The Homeless Vulnerable Populations: Focusing on the Homeless Introduction Homeless individuals live in extreme circumstances of poverty which results in their failure to dwell in a humane living environment as well as the inability to provide for their own needs. In the 1980s, the United States government estimated that around 200,000 to 500,000 Americans were homeless due to the budget cuts that were the result of an economic crisis (Wallace and Grossman, 2008). The homeless is a vulnerable population due to the physical, psychological, and social health risks that come with their poor lifestyle. Numerous health risks could be associated with the various causes of homelessness. For instance, minors who experience homelessness are at higher risks of illnesses due to their relatively weaker immune system as compared to adults. Moreover, homelessness due to natural disasters could cause a dramatic increase in lethal illnesses due to the unavailability of basic human necessities (Burt, Aron, Douglas, Valente, Lee, and Iwen, 1999). The following section shall elaborate on homelessness and its population, as well as explain the role of nurses in advocating and educating the homeless. The Homeless: Demographics Stewart B. McKinney defined a homeless individual as a person who “lacks a fixed, regular, and adequate night-time residence”. According to McKinney, a primary night time residency includes: a publicly or privately supervised dwelling which serves as a temporary living accommodation; an institution or charity that provides temporary shelter for individuals who need to be institutionalized; and a public or private place that is not intended to serve as a shelter for human beings. In addition, a person who is imprisoned under a state law is not a homeless individual (U.S. Department of Agriculture, Rural Economic and Community Development, 1996). In the past 25 years, two trends could be attributed to the rise in homeless individuals, namely: the shortage in cheap rentable dwelling; and the concurrent increase in poverty. In general, individuals living in poverty are more likely to become homeless (Wallace and Grossman, 2008). Ethnicity The ethnicity of the homeless population is different depending on the geography. Rural areas have higher numbers of homeless Caucasians and Native Americans (U.S. Department of Agriculture, 1996). In 2004, the U.S. Conference of Mayor conducted a study in 27 U.S. cities and found that the homeless population comprised of 49% African-America, 35% Caucasian, 13% Hispanic, 2% Native American, and 1% Asian (U.S. Conference of Mayors, 2001). Age In 2003, 39% of the homeless population were children below 18 years of age, while 42% of those children were below 5 years old. Moreover, 5% of the urban homeless population were unaccompanied minors. It was also recorded that there were higher numbers of homeless children in rural areas. In 2004, individuals from 25 to 34 years old comprised 25% of the homeless population; and 6% were individuals from 55 to 64 years old (U.S. Conference of Mayors, 2005).. Family Homeless families with children have increase significantly in just a short period of time. In a 2005 survey of 25 cities in United States, 33% of the urban homeless population were families with children (U.S. Conference of Mayors, 2005). In rural areas, families, single mothers, and children comprise majority of the homeless population (Vissing, 1996). Due to the increase in homelessness and decreasing number of affordable housing, incapable families end up staying for extended periods in shelter systems. In the 1990s, New York families were found to have stayed in shelter systems for an average of 5 months. Much worse, current stays average 7 months, while some studies recorded up to a year in stay average (U.S. Conference of Mayors, 2005). Domestic Violence Individuals experiencing domestic violence are forced to decide on whether to stay in abusive households or be homeless. It’s physical and psychological effects on the victim could cause the person to leave their household. In a study conducted on 777 homeless parents, who were mostly mothers, in 10 American cities, it was found that 22% left home due to domestic violence (Homes for the Homeless, 1998). In another study conducted in 2003 on 100 homeless mothers in 10 U.S. cities, 25% were physically abused within the last 12 months. Among the 24 cities studied by the U.S. Conference of Mayors, 12 cities indicated domestic violence as a primary cause of homelessness (U.S. Conference of Mayors, 2005). All in all, American women and children have higher cases of leaving home due to domestic violence. Sexual abuse has been given much attention and research by the nursing sector in order to properly treat such traumatic experiences. Other Causes Other causes of homelessness include: economic crises leading to unemployment; natural disasters; children who get thrown out by parents due to family issues; failure of housing projects; and inadequacy of mental healthcare institutions to reach those in need (U.S. Conference of Mayors, 2005). Problems in the economy often lead to an increase in unemployment as well as higher prices of consumer goods. Natural calamities such as earthquakes and tornadoes are capable of razing homes and buildings which leads to spontaneous homelessness. It is important for the government to provide temporary shelters or new homes for those affected by the disasters as failure to do so may cause permanent or extended homelessness. Another common cause of homelessness is poor mental health. Veterans and individuals who had traumatic experiences should be given necessary mental healthcare as such issues may affect their decisions and lead to homelessness. Vulnerability: Health Issues Among the homeless population in United States, health issues comprised of: 58% are unable to eat regularly; 55% do not have health insurance 46% have chronic health conditions such as cancer and diabetes; 30% have issues with substance abuse; 26% have acute health issues such as tuberculosis and pneumonia; 22% are mentally ill or disabled; and 3% have HIV/AIDS (Burt, Aron, Douglas, Valente, Lee, and Iwen, 1999). Food is a basic necessity that homeless individuals have difficulty acquiring. Lack of food could lead to malnutrition followed by illnesses such as ulcer and cancer in the digestive track. In addition, every person has the right to have access to basic necessities. However, economic and social barriers keep the homeless from acquiring humane sources of food (Wallace and Grossman, 2008). Homeless individuals with chronic health conditions have more serious need for proper healthcare (Boyd, 2008). On-going healthcare conditions require immediate diagnosis and treatment, since the long such illnesses last, the worse it could get if left untreated. Mental illness is one of the urgent health issues among homeless people (Austin and Boyd, 2010). Early treatment of mental illness could straighten the decision making of individuals and keep them from resorting to fleeing home due to traumatic stress or mental disorders. U.S. Department of Health and Human Services: Healthy People 2020 Goals Two of the most applicable goals that address the needs of homeless people are (1) access to health services and (2) public health infrastructure. Access to Health Services This aims to improve the availability of quality and comprehensive healthcare services, as this is necessary in increasing the quality of health for every person regardless of the socio-economic status. This section has 4 components: coverage, services, timeliness, and workforce (Committee on Leading Health Indicators for Healthy People 2020, Institute of Medicine, 2011). According to the Committee on Leading Health Indicators for Healthy People 2020 (2011), Access to health services requires 3 steps: gaining entry to healthcare services; accessing healthcare locations where specific services are available; and finding a healthcare provider that the patient can trust and communicate easily. The ease and availability of healthcare could yield: better physical, social, and mental health; prevention of illnesses; identification of health issues and treatment; increased health quality; prevent death; and extended life expectancy (Committee on Leading Health Indicators for Healthy People 2020, Institute of Medicine, 2011). Limited access to healthcare services could negatively affect the health of an individual. Hindrances to healthcare access include: high cost; lack of insurance; and lack of adequate availability. Such hindrances could result to: delays and inability to acquire treatment; and unnecessary hospitalizations that could be prevented. Public Health Infrastructure This aims to ensure that local health institutions have adequate infrastructure to provide necessary healthcare services at all socio-economic levels (Committee on Leading Health Indicators for Healthy People 2020, Institute of Medicine, 2011). An efficient healthcare infrastructure is able to provide services to acute and chronic healthcare problems. Public health infrastructure is made up of 3 components, namely: qualified and capable workforce; up-to-date healthcare systems; and healthcare institutions that are able to assess and respond to healthcare problems. These 3 components are needed to achieve the 10 Essential Public Health Services: (1) monitor health status; (2) diagnose and investigate; (3) infor; educate, and empower; (4) mobilize community partnerships; (5) develop policies and plans; (6) enforce laws; (7) link people to healthcare services; (8) ensure competent healthcare workforce; (9) evaluate adequacy of healthcare services; and (10) research for new solutions and insights (Committee on Leading Health Indicators for Healthy People 2020, Institute of Medicine, 2011). Other Healthcare Goals The Healthy People 2020 goals of the U.S. Department of Health and Human Service also cover other health concerns that affect homeless individuals. Among these goals are: cancer; diabetes; disability and health; early and middle childhood; environmental health; HIV, nutrition and weight status; injury and violence prevention; mental health and mental disorders; substance abuse; and sexually transmitted diseases (Committee on Leading Health Indicators for Healthy People 2020, Institute of Medicine, 2011).. Certainly, the 2020 goals cover all the health issues related to homeless people. However, these goals could only be delivered through the availability of healthcare services from public health infrastructures. Personal is Political The phrase “personal is political” refers to the rights of an individual. For the homeless person, the phrase means the following: right to protection from domestic and sexual abuse; right to proper wage; and right to quality healthcare services (Sherman, 1989). Domestic and sexual abuse is one of the most common causes of homelessness (Sherman, 1989). The stress and fear from staying in a household where abuse is prominent often force an individual to leave their home. It is important for the people to know that there are state laws that protect our sexuality and physicality from violence and that such abuse are punishable by law. Unemployment and maltreatment in the workplace is leading cause of poverty, which could also result in homelessness. A job is the only stable source of income of an individual. Every person is protected by laws that prevent employers from maltreating its workforce through improper work ethics and wage cuts (Sherman, 1989). Lastly, every individual has the right to access quality healthcare services regardless of their socio-economic status. Proper healthcare results in the preservation of life. Homeless individuals are prone to both mental and physical illnesses which if left untreated, it could lead to death. Local healthcare institutions are given budget priorities in order to improve its infrastructure and healthcare system with the aim of effectively responding to both emergency and on-going health conditions (Sherman, 1989). Advocacy and Education Nurses are one of the first healthcare personnel to respond to a patient (Lundy, and Janes, 2008). This is a good opportunity for nurses to inform the patients regarding their condition and the risks that come with their lifestyles. In cases where hospitals dispatch healthcare groups for community outreach, public seminars could be conducted in order to educate people especially the poor about the illnesses and availability of healthcare to them (Lundy and Janes, 2009). Such seminars could change the perception of the poor that healthcare services are only available to those who can pay for it. There are federal programs that aim to provide shelter and meals for the homeless as well as healthcare support (Hitchcock, 2003). Conclusion Homelessness is a deep problem in the society. It is not only caused by poverty, but also by social problems present in the family. Both the mental and physical health of an individual is at risk due to homelessness. Today, more than half a million Americans are homeless, and such number is still increasing due to economic and social problems. The 2020 Healthy People goals of the U.S. Department of Health and Human Services address the health issues associated with homeless people. Providing accessible healthcare services through effective healthcare infrastructures are the main foundations to addressing the other health issues of homeless individuals. Personal is political is a phrase that could be addressed to the homeless since it reminds them of their rights to basic necessities and protection from abuses. In addition, nurses are among the first medical personnel to come in contact with patients. They have the opportunity to be the first to inform and educate patients of their illnesses and how to prevent such sickness through medication and change in lifestyle. Local healthcare institutions have made necessary steps in improving the delivery of healthcare services in order to reach out to all patients at all levels. The homeless is a vulnerable population due to the numerous health risks they face without much knowledge of the availability of healthcare services. They should be given attention and shall be educated regarding their conditions and the treatments available for them. References Austin, W., and Boyd, M. (2010). Psychiatric and mental health nursing for Canadian practice. Philadelphia: Lippincott Williams and Wilkins. Boyd, M. (2008). Psychiatric nursing: Contemporary practice. Philadelphia: Lippincott Williams and Wilkins. Burt, M., Aron, L., Douglas, T., Valente J., Lee, E., Iwen, B. (1999). Homelessness: Programs and the People They Serve. Washington, D.C.: Interagency Council on the Homeless. Committee on Leading Health Indicators for Healthy People 2020, Institute of Medicine (2011). Leading Health Indicators for Healthy People 2020: Letter Report. Washington D.C.: National Academies Press. Homes for the Homeless (1998). A snapshot of family homelessness across America. New York: Institute for Children and Poverty. Hitchcock, J. (2003). Community health nursing: Caring in action. Connecticut: Cengage Learning. 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Out of sight, out of mind: Homeless children and families in small town America. Kentucky: University Press of Kentucky. Wallace, M., and Grossman, S. (2008). Gerontological nurse certification review. New York: Springer Publishing Company. Read More