Running Head: HOMELESSNESS AND INCREASED MORBIDITY AND MORTALITY 1

Homelessness and Increased Morbidity and Mortality

Ellen D. Sowder

Professor Kathy S. Faw RN, MSN

Bon Secours Memorial College of Nursing

NUR 3113

October 30, 2016

Honor Code “I pledge.”

HOMELESSNESS AND INCREASED MORBIDITY AND MORTALITY 2

Health Outcomes of the Homeless

When considering vulnerable populations, it is easy to focus on groups that one does not

often come in contact with. Many people think that extreme poverty and poor access to

healthcare is something that Americans do not have to worry about. Sadly, this is far from true.

Many people, even within our meager city, are deeply impoverished and have poor health

outcomes because of this. A vulnerable population is a group of people that are not privy to the

benefits of being in the majority. Often these groups are marginalized and forgotten in terms of

healthcare and access to help. Poor health outcomes for the homeless are a good choice when

discussing vulnerable populations because it is a group that is hidden in plain sight. As the

modern day lepers, these people are often brushed off throughout the day and considered to be an

annoyance to society. However with high instances of substance abuse and mental illness

accompanied by the high stress of living insecurity, it is easy to see why the homeless population

experiences a higher rate of morbidity and mortality than the general population.

Social Determinants of Health

Social Determinants are defined by Healthy People 2020 as “conditions in the

environments in which people are born, live, learn, work, play, worship, and age that affect a

wide range of health, functioning, and quality-of-life outcomes and risks.” Some examples of

social determinants include availability of resources, education, access to healthcare, social

support, and environmental safety. As one can imagine, someone who is without a home is very

disadvantaged in terms of access to support physically or psychologically. At the most basic

level, shelter is one of the most important human needs. This is the bottom level of Maslow’s

Hierarchy of needs, which insinuates how all other aspects of health cannot be achieved without

this basic one. According to the Western Journal of Emergency Medicine, “The homeless
HOMELESSNESS AND INCREASED MORBIDITY AND MORTALITY 3

population is vulnerable due to limited self-care ability, substance abuse and co-morbidities

(Turner, 2016). This leads to bad health outcomes for homeless people by having to use the

Emergency Department for Primary health care (if they seek primary health care at all),

increased hospitalization due to addiction and mental illness, as well as co-morbidities such as

infection and disease that complicates wellness. In a study from the University of California,

38.2% of the homeless people who were released from hospital care were readmitted within 30

days (Lam, 2016). More than one-third of this population needing readmission to the hospital is

a concerning statistic proving that something in this population’s health outcomes is going very

wrong. There are many aspects that play into this. For instance, if a homeless person has to have

surgery or a procedure that requires gentle or specific recovery techniques, it makes sense that

someone who does not have a home would not be able to effectively accomplish this. Another

aspect that plays into hospital readmission is the prevalence of substance abuse and mental

illness. In the same study from USC, the proportion of readmissions to the hospital from the

homeless population that was because of mental illness was 21.5% (Lam, 2016). Mental illness

is a complicated issue that often requires numerous medications and specialists. At this point,

one might consider that mental illness is often the reason for someone’s homelessness, therefore

magnifying the poor health outcomes that go along with forced noncompliance of mental illness

treatment because of instability with one’s basic human needs. If someone is too mentally ill or

addicted to substances or alcohol to keep a job or home, it is unrealistic to expect him to be able

to follow medical advice about potential treatment for these diseases.

Addressing Health Needs for the Homeless Community

In discussing Millennium Development Goals, the main ones that relate to the topic of

homelessness and increased morbidity and mortality are eradicating extreme poverty, achieving
HOMELESSNESS AND INCREASED MORBIDITY AND MORTALITY 4

universal primary education, and combating disease. Some of the services that need to be

expanded at homeless shelters and offered to the general homeless population are counseling

services, rehabilitation, sub-acute care, and transportation. The idea that housing is a

fundamental right, and not a privilege for those who can afford it is the first step towards

minimizing health disparities in the homeless population. If more steps can be taken to offer

housing to those in need, charitable groups and people can come provide services like life-skills

training and literacy help that will increase this populations ability to take care of themselves and

in tern achieve better health outcomes. Unfortunately, these dorm-style living situations can

cause a greater spread of disease. To help combat this, it would be important to provide more

screenings and primary care as well as have the ability to isolate tenants that are found to have

communicable diseases such as tuberculosis. 15% of individuals with serious mental health

conditions suffer from homelessness (Lam, 2016). This group would greatly benefit from group

housing and counseling. This would provide a safe place for them to keep their medications as

well was some reminders to take them. Also, having some mild supervision could potentially

prevent mental crises from happening by being able to predict the onset of one, and take the

proper measures, such as calling the hospital or police. In addition to these, studies have shown

that most homeless people prefer an avoidance-style coping or emotion-oriented coping when

faced with stressful situations. These coping styles have been associated with poorer health, are

less effective and do not lead to problem solving (Oapalach, 2016). This is another way that

rehabilitation and counseling will be beneficial to the overall health of this population.

According to the study based on coping in the homeless population, “the presence of excessive

alcohol consumption in this group of individuals may interfere with active participation in
HOMELESSNESS AND INCREASED MORBIDITY AND MORTALITY 5

support programs” (Opalach, 2016) therefore, lowering their chances of bettering themselves

without the help of rehabilitation and counseling.

Health for All

Homelessness is a topic that is discussed around the world. While the problems

vary between different countries, one aspect remains the same. Homelessness is blamed for a

mortality gap between them and that of the general public. One of the main ways that the barriers

of health can be eradicated is by greater involvement of Community Health Nursing. They can

participate in initiatives to provide sub-acute care, primary care, and screenings to the homeless

population. Another way CHNs can help, is visiting local homeless shelters to provide patient

education on common morbidities, offer information on resources and initiate a dialogue about

prevention and lifestyle modification. Most importantly, medical respite needs to be offered to

homeless people to ensure a better health outcome and lower rate of readmission to the hospital.

“Safety-net hospitals, those that disproportionately care for persons of low socioeconomic status,

have higher readmission rates and will have to innovate to avoid readmission rated penalties

(Berenson & Shih, 2012). Effective transitional care, particularly for the most vulnerable

patients, is needed to achieve and sustain health care reform under the ACA (Naylor, Aiken,

Kurtzman, Olds, & Hirschman, 2011). Both of these statements address the need for medical

respite for homeless people. This would allow homeless people a period of housing stability to

encourage rest and recovery in a safe place with support services. Having transitional care for the

homeless would encourage better health outcomes for them while helping to reduce readmission

rates and help mitigate already crowded Emergency Departments. This also allows a time to help

provide resources to these people such as information about housing and health care.

Conclusion
HOMELESSNESS AND INCREASED MORBIDITY AND MORTALITY 6

There is really no downside to working towards a greater common denominator of health.

Some increased costs upfront to help provide housing and health services to homeless people in a

preventative fashion, will decrease medical costs in the long run. Lack of support post

hospitalization, substance abuse, and mental illness all increase the level of mortality that can

often be prevented through small measures. Increased education, involvement of community

health nurses and options for medical respite will help decrease the readmission rate of homeless

people to the hospitals. Most importantly, looking at this vulnerable population as part of our

own community will help increase the services and help available to them. In turn this will

hopefully lower the extreme health disparities currently seen between the homeless and those

whose housing is assured.

HOMELESSNESS AND INCREASED MORBIDITY AND MORTALITY 7

References:

Biederman, D. J., Gamble, J., Manson, M., & Taylor, D. (2014). Assessing the Need for a Medical Respite:

Perceptions of Service Providers and Homeless Persons. Journal of Community Health Nursing, 31(3),

145-156. doi:10.1080/07370016.2014.926675

Hauff, A. J., & Secor-Turner, M. (2014). Homeless Health Needs: Shelter and Health Service Provider Perspective.

Journal of Community Health Nursing, 31(2), 103-117. doi:10.1080/07370016.2014.901072

Lam, C., Arora, S., & Menchine, M. (2016). Increased 30-Day Emergency Department Revisits Among Homeless

Patients with Mental Health Conditions. Western Journal of Emergency Medicine, 17(5), 607-612.

doi:10.5811/westjem.2016.6.30690

Opalach, C., Romaszko, J., Jaracz, M., Kuchta, R., Borkowska, A., & Buciński, A. (2016). Coping Styles and

Alcohol Dependence among Homeless People. Plos One, 11(9). doi:10.1371/journal.pone.0162381

Taylor, E. M., Kendzor, D. E., Reitzel, L. R., & Businelle, M. S. (2016). Health Risk Factors and Desire to Change

among Homeless Adults. Am J Hlth Behav American Journal of Health Behavior, 40(4), 455-460.

doi:10.5993/ajhb.40.4.7
HOMELESSNESS AND INCREASED MORBIDITY AND MORTALITY 8

Section 1 15 10

Introduction  The introduction is captivating as it  The introduction lacks  The introd

reflects on the meaning of captivation but clearly states the meaning o
vulnerable population. meaning of vulnerable population
 Identifies a vulnerable population population. identificatio
and states the reason for the  Identifies a vulnerable population
choice. population but lacks reason for
choice.

 The conclusion is recognizable

 The conclusion is clearly defined
summarizing the key factors
influencing the health status of the
identified vulnerable population.
Conclusion
and attempts to summarize the
 No conclus
key factors influencing the
presented.
health status of the identified
vulnerable population.

Section 2 30 20

Social Determinants  The writer Identifies and reflects  The writer identifies the social  The writer
of Health on the social determinants of determinants of health. determinan
health as depicted in the literature.  The writer provides minimal discussing
 The writer discusses in detail the discussion relating health health outc
relationship between social health determinants to health identified v
determinants and health outcomes outcomes and fails to link it to population
for the identified vulnerable the identified vulnerable
population. population.
Section 3 30 20

Evidence-based  The writer identifies evidence-  The writer identifies evidence-  The writer
Interventions based interventions addressing based interventions addressing based inte
addressing Health the health needs of the identified health needs in general. linking them
vulnerable population.  The writer speaks to MDG’s vulnerable
Needs  The writer states and relates the with no relation to the identified depicts a l
significance of meeting the related vulnerable population. regarding
MDG’s in improving health
outcomes for the identified
vulnerable population.
Section 4 15 10

Global Approach in  The writer identifies and reflects  The writer mentions but  The writer
Addressing “Health on two global approaches in provides minimal reflection on reflection o
for All” eradicating barriers to health. one or two global approaches in approach i
 The writer relates the significance eradicating barriers and barriers an
of eradicating the chosen health promoting health for all. for all.
barriers in promoting optimal
health for all.

Section 5 10 5

Writing and  The paper is without grammatical  A few spelling and/or  The paper
Presentation and spelling errors. APA format is grammatical errors noted. Writer evidence o
evident. makes an attempt at APA has numer
format. no evidenc
HOMELESSNESS AND INCREASED MORBIDITY AND MORTALITY 9

**Assignments turned in late will be graded as above and then have point deduction taken per syllabus.