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Nursing care for patients who are homeless is challenging. As you develop a plan of care, consider the barriers they face and the available resources.
Credit: Getty Images/iStockphoto- Rates of homelessness are rising across the U.S. due to a lack of affordable housing.
- People experiencing homelessness experience barriers to healthcare including poor transportation, discrimination, substance misuse, and poor mental health.
- Nursing care for homeless patients must begin by addressing the common lack of trust while prioritizing needs, and advocating on a micro and macro level.
The number of people experiencing homelessness is rising faster than in past years, primarily due to a lack of sufficient income and affordable housing. According to data gathered by The Wall Street Journal from 150 organizations that count people experiencing homelessness, the numbers indicate a sharper climb than in recent years, underscoring growing pressure from rising costs.
According to the National Alliance to End Homelessness, the U.S. has experienced a 6% rise in homelessness since 2017, with record highs reached in 2022. As of January 2022, over 580,000 people in the U.S. were experiencing homelessness.
Nurses must face the challenges of providing care for patients who are homeless, houseless, unhoused, or unsheltered, often without adequate healthcare resources. Let’s briefly consider some of the barriers to care before offering several tips nurses can use to care for these patients.
Barriers to Care for People Experiencing Homelessness
Several barriers limit access to care for those experiencing homelessness, which can be nearly one-half million people on any given night. These barriers can make it difficult to access proper healthcare and increase the risk of chronic disease and premature death. Some of those barriers include:
- Poor access to reliable transportation
- Discrimination
- Poverty
- Lack of reliable access to clean water and electricity
- Substance misuse
- Poor mental health
- Negative past healthcare experiences
- Competing life priorities such as housing, safety, or transportation
- Lack of trust in healthcare providers and poor therapeutic relationships
- Affordability
Nurses working with these vulnerable populations often witness the results of these challenges when patients arrive at the hospital for care in poor physical and mental condition. Some healthcare providers are also not aware of the barriers that exist for individuals experiencing homelessness.
For example, when care includes medication that requires refrigeration or washing and changing a wound twice daily, it may not occur to the provider that the patient does not have access to consistent refrigeration or clean running water.
Those experiencing homelessness may not have a safe place to store their medication or wound supplies, and they may not follow recommendations when they do not trust healthcare providers.
Tips for Caring for Patients Experiencing Homelessness
Whether patients seek general healthcare or urgent treatment, nursing care for patients who are homeless requires an adept response to their living situation, compassion, and advocacy. These tips help healthcare clinicians address the healthcare needs of those experiencing homelessness directly and champion outreach programs that help them make healthier choices.
Use a Holistic Nursing Approach
Data demonstrates that nurse-led models of healthcare for those experiencing homelessness improve patient outcomes. Using a holistic nursing approach can help ensure optimal treatment for patients experiencing complex mental, physical, and social health problems.
Establish Trust
The first step to providing quality care is establishing trust. Listening to the patient and finding ways to bridge gaps is crucial for the healthcare provider’s understanding of how people experiencing homelessness care for themselves.
Assess Both Immediate and Long-term Needs
Nursing care for patients who are homeless must include prioritizing their immediate and long-term needs to make positive health-related changes and improve their quality of life. By using simple approaches, nurses can take the first steps in initiating case management, treatment for substance use, access to housing, or income assistance.
Provide Trauma-Informed Care
Using a trauma-informed approach, nurses can assist those experiencing homelessness in accessing medical homes or advocating for a broader approach to this societal challenge.
Advocate for Patients
Advocacy happens on the micro and macro levels. Nurses advocating for individuals who are homeless can help provide necessary items and services, such as clothing, phone calls, transportation, job opportunities, and survival kits containing items for cold and hot weather.
Through fundraising and working with corporate sponsorship, nurses can have a significant impact on their immediate geographical area. On a macro level, advocacy can focus on addressing the systemic causes to create lasting and permanent change. For example, working to bridge the housing gap through legislative change or organizing housing situations for large groups.
Resources for Nurses and Caregivers
Page last reviewed August 8, 2023
