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Running head: HOMELESS

Homeless: A Vulnerable Population Michael P Dugan Ferris State University

2 HOMELESS Abstract The homeless are an underserved and vulnerable population. This is due to physical, mental, and financial problems. Misunderstandings of the health care system by the homeless and biases portrayed by health care personnel also limit services provided to the homeless. Changing my perceptions of the homeless enables me to meet their needs with understanding and compassion. I am starting to learn that there are many different types of homeless people than just single men. The homeless live a difficult and dangerous life. It is hard to plan for the future when the homeless are trying to be accepted by society, feel connected to others, and keeping safe. Interventions include meeting immediate needs of the homeless patient, collaborating with community organizations to meet ongoing needs, developing courage and strengths in the patient, and advocating for the homeless patient.

3 HOMELESS Homeless: A Vulnerable Population The homeless population did not start out homeless. The homelessness of most people is preceded by financial, physical, and mental problems (Gerber, 2013). Financial problems can be caused by unemployment, lack of affordable housing, high cost of living, natural disasters, and indebtedness. Physical problems can be injuries, diseases, and disabilities that do not allow an individual to work. Mental problems can be substance abuse, mental illness, and abuse. Whatever the cause of a persons homeless status is, in the end it is somebody who lacks a fixed, regular, and adequate nighttime residence (Dykeman, 2011, Background section, para. 1). What causes the homeless to be a vulnerable and underserved population involves a number of factors. Being vulnerable means the homeless are a group of people that are at greater risk of poor health due to being underserved in their communities by local, state, and national injustices (Harkness & DeMarco, 2012). These injustices include physical ones such as lack of health insurance, limited access to primary health providers, poor follow up care, poor nutrition, and inadequate shelter. The social injustices also include negative perceptions and attitudes held by the communities where the homeless live. Lastly, the injustice may be self-imposed by homeless people by mistrust of authoritative organizations and the feelings of not being a normal part of society. My perception of homeless people mirrored the stereotypes and biases of the general public. I believed the majority of them were middle aged men with mental illnesses and substance abuse problems. I figured they did not like living on the streets but also thought they would enjoy less the responsibilities of maintaining a residence and caring for themselves. This paper intends to research the demographics of homeless people with an emphasis on self-analysis of my perceptions of the homeless before and after my research.

4 HOMELESS Homeless Demographics The National Coalition for the Homeless (NCH, 2009) indicates that the number of homeless people are increasing due to lack of affordable housing and an increase in poverty. According to the NCHs (2009) statistics, there are almost as many homeless families with children as there are homeless people with mental illnesses and addictions. The majority of the homeless is still single African American men, but there is bigger spread of homeless demographics than what was seen in the past. The majority of homeless are found in urban areas. There are not as many services in rural areas therefore homeless people tend to stay with family or friends and are not as visible. Nationally, three to five million people will experience homelessness in any given year, which represents approximately 1% of the national population (Dykeman, 2011, Background section, para. 3). Every community experiences homeless people. A house fire in which a family loses their home becomes homeless even if it is temporarily. In my community of Traverse City, the main local homeless shelter took in 454 men, 248 women, 83 children, and 56 families in 2012 (Goodwill Industries of Northern Michigan, 2013). Homeless people experience more health problems than the general public by as much as three to six times (Loewenson & Hunt, 2011). The correlation between poor health and

homeless people is well documented. Infectious diseases, trauma, and higher rates of chronic health conditions along with addictions and mental illnesses are seen in greater numbers in the homeless population. Getting homeless people in for treatment and follow up care is difficult because of money problems, transportation issues, lack of contact information, distrust from both ends, and possible lack of healthcare facilities.

5 HOMELESS Self-Reflection Nurses are socialized with the same stereotypes as the general population and they must identify their preconceptions in order to develop compassion when caring for people from underserved and disenfranchised populations (Loewenson & Hunt, 2011, Discussion section, para. 2). I am no different. I learned my stereotypes from family, friends, and coworkers. Learned is the keyword here. I can learn to change my stereotypes to a more accepting and understanding attitude. I have started this unlearning with the research conducted for this paper. The biggest preconception I had about the homeless was their demographics. I did not realize how many families with children were without homes. The majority is still single men and these are the most visible. Unless a person works directly with the homeless, one has no idea of the scope of the problem and who it involves. A second preconception was that I believed homeless people did not want any help. Even though their lifestyle was difficult, it was a lifestyle they chose and were comfortable with since they knew it. Dykeman (2011) states that the myth of homeless being treatment resistant is not true. The homeless often seek treatment when offered an open, flexible and on-site delivery of service (Dykeman, 2011, Background section, para. 5). The mistrust of health care personnel and the negative views by personnel of the homeless prevents the homeless from seeking health care help. Loewenson and Hunts (2011) study showed that nursing students who participated in service-learning clinicals with homeless people were able to change their negative preconceptions into positive attitudes regarding homeless people. I learned that I need to be more open minded and receptive in regards to the homeless and their experiences in order to deliver compassionate care. Perhaps some type of work related workshops would be helpful to my coworkers and I to help demyth the homeless.

6 HOMELESS A third preconception is that the homeless are perpetrators of crime in the community. Quite the opposite is true. Homeless people are often victims of crimes, living in a constant state of uncertainty, chaos, and fear (Gerber, 2013). Keeping themselves safe and out of harms way is a constant day to day problem. Police are perceived to not be helpful, therefore many crimes may not be reported. Theft is a concern whether in a shelter or sleeping outdoors. Homeless tend to keep their camps secret and frequently move from place to place. Due to these factors , the homeless are resilient in tolerating conditions that may incapacitate others. There is

camaraderie among themselves with a pride that they can survive tough situations. These situations also keep them living in the present without having any means or ability to plan for the future. Interventions that I could do as a nurse are to recognize the needs of a homeless person. First is to find out what are the immediate needs of the person. Making sure food, clothing, and shelter are available is important. Second is to consult with social work to set up collaboration in the community to meet ongoing needs. A third intervention is to help the person develop their strengths and courage. Debunking myths that the homeless have of health care personnel would be important for me to pursue. A fourth stage of intervention is to advocate for the person (Dykeman, 2011). I believe in helping patients to where they can start to help themselves. A study conducted by Thomas, Gray, and McGinty (2012) showed that the homeless perceive their wellbeing as accepted by society, keeping safe, having a connection with others, and feeling good about themselves. The homeless did not really link wellbeing and health together. I do connect wellbeing with health. The other factors such as being accepted,

connected, and safe are not problems in my life. To have that perception that my wellbeing criteria are different than those of the homeless is important in my understanding of the priority the homeless put on health care. Many live with chronic health conditions and have learned to

7 HOMELESS make do how they can. If I have health problems I seek help right away. My priorities are different. It is important for me as a nurse to find out what my homeless patients priorities are and help them get those priorities taken care of while delivering compassionate, unbiased health care. Conclusion The homeless are a vulnerable and underserved population related to them operating outside of the mainstream of society and financial, mental, and physical problems. Distrust and lack of understanding of health care institutions and negative attitudes toward the homeless also perpetuates this health disparity. I have the general publics preconception of the homeless. Through research I have started to change my attitude and perception of the homeless. The homeless are more than just single men, they are also families with children who are homeless for a number of reasons. Loss of or inability to work and lack of affordable housing are the main reasons for homelessness. The homeless do seek help when it is provided in a way that is flexible and accessible to them. Homeless people live a hard life and it is only a few of them that make it into the news due to crimes. Making sure a homeless person has basic lifes necessities before moving on to longer term interventions is important. My sense of wellbeing is different than the homeless. I connect wellbeing with health while the homeless connect wellbeing as being accepted by society, feeling connected to others, and keeping safe. It is my process of changing my biases about the homeless that will benefit them in the long run since I will be more open in meeting their needs with more understanding and compassion.

8 HOMELESS References Dykeman, B. F. (2011). Intervention strategies with the homeless population. Journal of Instructional Psychology, 38(1), 32-39. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=2011243539&site=e host-live Gerber, L. (2013). Bringing home effective nursing care for the homeless. Nursing 2013, 43(3), 32-39. Goodwill Industries of Northern Michigan. (2013). Goodwill Inn impact section. Retrieved from http://www.goodwillnmi.org/homeless-housing/goodwill-inn-homeless-shelter/ Loewenson, K. M., & Hunt, R. J. (2011). Transforming attitudes of nursing students: Evaluating a service-learning experience. Journal of Nursing Education, 50(6). doi: http://0dx.doi.org.libcat.ferris.edu/10.3928/01484834-20110415-03 Harkness, G. A., & DeMarco, R. F. (2012). Community and public health nursing: Evidence for practice. Philadelphia, PA: Wolters Kluwer Health | Lippincott Williams & Wilkins. National Coalition for the Homeless. (2009). Why are people homeless section. Retrieved from http://nationalhomeless.org/factsheets/why.html Thomas, Y., Gray, M. A., & McGinty, S. (2012). An exploration of subjective wellbeing among people experiencing homelessness: A strength-based approach. Social Work in Health Care, 51(9), 780-797. doi:10.1080/00981389.2012.686475