Bringing Healthcare to the Homeless

Bringing Healthcare to the Homeless

Introduction

There are many issues affecting peoples’ lives in the world, one of them being homelessness.  In recent years, the number of individuals experiencing homelessness has surged and this has been blamed on the concurrent cuts in social and housing services.  For instance, in London, 6,437 persons were rough sleepers during 2012/13, representing an increase of 62 percent over two years (Lamb & Joels, 2014).  Homelessness has a negative impact on an individual’s physical and mental health.  Some of the health concerns prevalent among the homeless are drug and alcohol-related problems, poor hygiene, effects of cold weather, and nutritional deficiencies.  In most cases, the physical and mental health requirements of this special population are usually managed inadequately in primary care.  Given the daily concerns of finding shelter and food, the homeless populations do not always regard health as an immediate priority.  This calls for a targeted health promotion directed at the homeless persons.

This paper will present an outline of a health advocacy campaign that will provide strategies and probable solutions to help bring healthcare closer to the homeless.  Advocacy enables one to gain new and increased resources for preventing, curbing and ending homelessness.  This epidemic has to be addressed as soon as possible to help improve the quality of life.

Who are the Homeless?

From the report given by the Department for Communities and Local Government (DCLG), an individual is said to be homeless if he or she does not have accommodation completely in which they own a lawful right to live in, and which is physically obtainable and available to them, and is reasonable for the entire household to continue residing in.  Homelessness manifests itself in various forms.  A majority assume that only the rough sleepers represent the homeless population.  Nothing could be further from the truth as hostel dwellers and sofa surfers can also be considered as homeless (Taylor et al., 2012).  Knowing the exact number of homeless persons is always a tall order since they hardly feature on any comprehensive formal record or register that would facilitate their counting.

Past Campaigns

Over the years, there have been various local programs run by public agencies, private clinics and police which have helped the homeless access better health and mental health care.  Nonetheless, barriers to bringing healthcare to the homeless remain.

Day programs are a good example of local programs.  Day programs offer health services in locations where homeless persons are found and unlike sheltered clinics, their sites are independent of residential programs.  St. Francis House in Boston is a good example of an institution offering day programs.  It provides the homeless with various vocational guidance and mental health services in a single building.  The health services rendered also include a health clinic for the homeless that is staffed by paid employees and volunteers.  The Cardinal Medeiros Day Center is another day program in Boston that is solely for the elderly homeless persons.  This day program also includes a food van that stops over in places where the homeless are common.  Two nurses alternate between the medical centre and the van and hence, both are familiar with both programs and easily identified by the homeless.  Even though the nurses involved report that this program accords them little opportunity to conduct comprehensive tests on the homeless, they acknowledge that the real value of the program emanated from gaining the trust and confidence of the homeless.

Recently, there has been a program where police officers in Springfield employ iPads to arrange video chats between the homeless and mental health practitioners at Burell Behavioral Health.  The police officers trace the homeless persons in the streets, provide them with iPads, and then let them go and talk to health professionals at a location of their liking.  The professionals at Burell conduct quick assessments or set the homeless up for inpatient care or future appointments.  Regarding the success of this model. Cpl. Chris Welsh, a crisis intervention team coordinator at Springfield Police Department, asserts that the model has proved to work way much better than compelling the homeless to do jail time or a 96-hour hold (Rehwald, 2017).

Unfortunately, there does not exist a statistical basis to ascertain the success of these programs.  However, the fact that major features of these models constantly feature in later programs can lead one to the conclusion that these models of service delivery are effective.

Proposed Plan

To improve the accessibility of healthcare among the homeless, this paper proposes the use of a more extensive mobile health clinics with specialized personnel.

Objective:  To bring healthcare to the homeless.

It is crucial to design services for the homeless in a manner that keeps the provider mobile and portable.  Often, the homeless are apprehensive of institutional systems and services and thus, it is improbable that fixed and institutional service structures can effectively offer meaningful services to this population.  It is for this reason that this paper proposes the use of mobile health clinics to bring healthcare closer to the homeless.  Even though mobile health clinics already exist for the treatment of the general public and have reported success, they are hardly used to deliver health services to the homeless.  According to studies, employing mobile clinics may encourage the homeless to attend existing health services (Zlotnick, Zerger, & Wolfe, 2013).

The mobile health clinic proposed will involve nurse practitioners, nurses and substance abuse counselors who will travel around in special vans bringing healthcare in areas occupied by homeless people.  The patients will be able to receive various services ranging from routine health check-ups, treatment for illnesses, as well as dental and mental health services.  Outreach workers will also form part of the team and they will be tasked with finding the homeless persons and developing trust and a relationship with the homeless to encourage them to access services.  To pinpoint this population, a search will be conducted on abandoned buildings, street benches, encampments, under bridges, and parks.  For the homeless individuals with severe health care needs but reluctant to access services, health care professionals will accompany outreach workers.

Studies have established that the following four elements enhance a program’s capacity to offer health care services to the homeless: communication, coordination, targeted approach, and internal and external resources.  Therefore, the proposed model will incorporate these four elements among others.  With regard to communication, the campaign will involve the use of social media platforms to increase awareness of the program’s initiatives as well as look for the homeless persons.  With the mobile program, homeless persons without health insurance will be able to receive health care services.  The mobile health outreach approach is merited by its success in curbing some of the barriers to health care access.  While mobile clinics come in handy with regard to healthcare provision, they are inadequate to meet the complex health care needs of most homeless persons who require comprehensive services (Post, 2007).  Therefore, the mobile clinic’s program will be complemented with services from a major health care provider.

Ethical dilemmas during advocacy campaign

There are several known dilemmas that the nurses undergo during advocacy campaigns. However, professionals have come up with viable ways in which this dilemma can be resolved. Below, a number of these challenges and the ways through which they can be resolved are discussed.

• Knowing at which point should the nurse chip in to defend the baby and the mother: the instant where education about the use of formulas should be provided by the nurses in case the mother breastfeeding should be identified as the mother is losing too much weight. This dilemma should be resolved through nurses’ advocacy for both the mother and the baby. If these formulas are essential for the survival of the baby, then sidelining of the Baby Friendly initiative is done. The nurses should make use of autonomy by giving permission to the mother of determining her best way of feeding her infant. The mother should make concrete choices through the quality education that is the offer by the nurses advocating on the importance of breastfeeding the baby. The positive attitude should be practised during the support of the patients. Nurses act as advocates for the new moms such that, if the mother makes a decision of not breastfeeding her baby, then her decision should be respected and be treated fairly. Breastfeeding is vied under different perspectives, either as a way of life for some or a choice for some. This means that some mothers will prefer breastfeeding their babies whereas other would prefer using formulas.
• Administrator acting as an evaluator: this is another possible ethical dilemma that may arise during advocacy campaign. To resolve this dilemma, a designation should be done. This is where one individual is assigned the role of coordinating the program and another different person is given the role carrying out evaluations for the program to get rid of role conflicts. Besides the stated conflict, the supporters that have a special affection to the advocacy program may challenge the evaluators. These supporters tend to defend the program because of their peculiar affection to the program. The defence may extend to the members during the campaign evaluation aspect. Another possible means of resolving this dilemma is by making sure that the breaching of the confidentiality is not done and also ensuring that the statistical data is in the form of numbers.
• Autonomy: This is also a major ethical dilemma that is arising. A vast majority of those people who smoke have a feeling that if a policy of a free-smoke is executed, then their “right” decision is fringed. This dilemma can be resolved by prioritizing on the protection of the passive smokers from the toxic effects of tobacco that is being smoked by the active smokers. Nurses are therefore called upon to focus on their commitment to defending the patients by use of mutual efforts to ensure that the welfare of their communities is improved.

Applicable ethical and lobbying laws

Various definitions of lobbying have been put in place making most people think that they can define it well but they cannot. What does lobbying mean? Lobbying simply means the considered effort to effect political choices through numerous procedures of advocacy focused at representatives on behalf of another individual, group or crowd. This is the best broad definition as compared to other definitions. There are a number of applicable laws and of lobbying and ethics, these laws include:

1. A nurse should not engage in or tolerate deceit, dishonesty, misrepresentation or fraud when acting in the aptitude or personality of a certified nurse. Any nurse should not forge anything in form of signatures to access personal interests such as furthering their studies or engage in personification processes.
2. A nurse should not take part in sexual harassment with a co-worker. A disciplinary action is recommended for any nurse who engages in and sexual contact and inappropriate physical with a workmate in form of probation for six months and continuing credits in education in the sexual boundaries area at the place of work. As a nurse, one should be very keen not to violate any law. However, this act will not extend to make the license of an individual to be suspended.
3. A nurse should not engage in deceit to obtain a license before successful completion of the course.
4. Nurses must not use their license deceptively or fraudulently.
5. A nurse must not participate in any that is not consistent with normally recognized expert morals in the practice of registered nursing takes part in a behaviour that infringes the professional code of morals.

Special Ethical challenges

During the Health Advocacy Campaign, there are a set of challenges that come our way. These challenges are normally unique to the target population of address. Some of these challenges are illustrated below:

The first one is finding a way of engaging the public in a precise subject. While in the field for the purpose of the community health advocacy, it might be difficult at times to deduce the proper approaches to engage the target population to discuss the subject matter. They might seem to know what you are advocating against and the might end up not according to you the necessary time to point out the intended objectives of the campaign.

Understanding the objectives. During the campaign, time can be taken by the nurse to educate the public on an issue but the then they cannot understand. In the instances, the community takes the issues that are addressed in such campaigns are not taken seriously. This renders the work of the nurses of the nurses difficult.

Attacks which are more direct and personal. In other communities, it is difficult to train them. As a result of their hostility, they might attack the nurses during the campaign. Other communities can as well attack the nurses during the base of the campaign on their identity and fail to listen to the content of their issues being addressed.

Inability to qualify a healthcare is another challenge. Nurses may lack all the necessary back up, collective responsibility and support from the population in which they are advocating. This renders the nurses’ efforts of qualifying a healthcare are unsuccessful.

Evaluating the advocacy efforts

At the start of any program, a formative evaluation is carried out. This must focus on a research that must be conducted to come up with intervention. The evaluation focus is to investigate the task and procedures that are mandatory in executing a program or energy.The focus of an outcome evaluation is to examine the worthiness of an effort or program even if the short-term goals have been attained.Another evaluation focuses on the examination of whether long-term goals has led to the effort; this is known as impact evaluation which is a comprehensive class of evaluation program.Qualitative data may be used for evaluation program.This data is based on non-numerical finding gathered systematically through well-known approaches to social science. The same evaluation can be carried out by use of quantitative data which compresses of variables that are numeric and are either continuous or discrete.

Conclusion

This paper has exhaustively discussed a review of most approaches that are involved in carrying out a community health advocacy. The paper has gone ahead to provide illustrations by different organizations, coalitions and groups in an international set-up. There are very vital and processes that have been identified together with possible barriers to them. Despite the fact that many advocates may not be in a position to get such obstacles confronted, it is clear the successful community health advocacy calls for endurance and energy investment and assessments to vacate changes and long-term visualization.

References

Lamb, V., & Joels, C. (2014). Improving access to health care for homeless people. Nursing Standard (2014+), 29(6), 45.

Post, P. (2007). Mobile healthcare for homeless people: Using vehicles to extend care. Nashville: National Health Care for the Homeless Council.

Rehwald, J. (2017). Local programs are improving mental health care for homeless; barriers remain, experts say. Namistl.org. Retrieved 16 March 2018, from https://www.namistl.org/local-programs-improving-mental-health-care-homeless-barriers-remain-experts-say/

Taylor, K., Naylor, H., George, R., & Hammett, S. (2012). Healthcare for the Homeless: Homelessness is bad for your health.

Zlotnick, C., Zerger, S., & Wolfe, P. B. (2013). Healthcare for the homeless: what we have learned in the past 30 years and what’s next. American journal of public health, 103(S2), S199-S205.