As individuals that are constantly in touch with disease and precarious living conditions, the homeless are at a higher risk of infection and death than those who live in better conditions. The prevalence of the disease in the homeless has reached an all-time high of 55%, with at least 3 to 6 times more likelihood of succumbing to disease than their housed counterparts. On average, the life expectancy of a homeless person is around 44 years, which is just 1 year lower than in the 14th century, when the bubonic plague ravaged Europe. Compared to the general population, which live to around the age of 78. On average, those in conditions of homelessness are evidently at higher risk for life-threatening conditions and diseases.

The rate of chronic disease, in particular, is alarming, considering that a large number of homeless adults suffer from at least one chronic condition. Furthermore, this risk increases as the person grow older. At least 30% of homeless adults suffer from hypertension, which almost doubles the incidence of the disease in the general population. In terms of mental disease, the homeless are also at a higher risk than housed individuals, with an incidence of around 37%, compared to 10% of the general adult population. In addition to this, endangering habits such as alcoholism are also widely prevalent in these individuals. With a rate of around 84% and 58% in homeless men and women, respectively, compared to 8% in the general population.

The high risk of comorbidity, coupled with the frequent hospital hopping, which has become commonplace in the homeless population in the month preceding their death. Alongside the lack of resources required to maintain the treatment after their discharge from the hospital. This has made providing quality care for these individuals an uphill battle.

The Importance of Nurse Advocates for Homeless Patients

As a nurse, treating a homeless individual can feel like a pointless battle. Some professionals might even believe that lending aid to them is more of a hindrance than a benefit to the patient, as patients are often readmitted after their discharge, only to find that they are back because they failed to adhere to the treatment issued upon their discharge. Furthermore, a 2005 study wrote that some of the homeless voluntarily “hospital hop” to find shelter and food, which could be the case for a few.

However, despite initial appearances, there might be more to these recurrent hospital visits than meets the eye. When sitting down to converse with homeless patients during their hospital stays, listening to their life story, or simply lending a genuine listening ear, patient satisfaction improves significantly, and the rate of readmission decreases in return. This is where nurse advocates for homeless patients enter as, by providing quality and compassionate care, as well as specific nursing strategies for their assessment and discharge planning, nurses are a pivotal piece in helping the homeless to manage their chronic diseases and prevent early deaths.

Initial Assessments

When admitting and performing the initial assessment of the patient, the very first step to ensuring a positive rapport is to create a safe space where the patient feels comfortable when answering your questions. To this end, you should be patient and give them enough time to answer each inquiry. If they are having trouble understanding or answering a question, remain patient and give them time, or try to rephrase the sentence. For homeless patients, it’s imperative that you give them enough space for them to explain their current situation, as this information will be pivotal in creating a proper discharge plan later on. 

Nevertheless, the questions shouldn’t be carved in stone, as they are when capturing information from other types of patients. In this sense, the medical history should be somewhat adapted to the patient’s housing and behavioral situation, as well as their physical health, and access to healthcare resources. To this end, try to use ample, open-ended questions that will help you understand their specific predicament. 

Lastly, consider that, since the homeless have limited access to dental care, bathing facilities, and food, pay special attention to their teeth, skin, and feet. Check for any signs of infectious diseases, malnutrition, or other potential problems that could arise in their specific context, such as hypothermia during the winter, or dehydration in the summer.

Discharge Planning

Due to the circumstances of homeless individuals, proper discharge planning poses a challenge for any healthcare facility. The Joint Commission states that all patients should receive a safe discharge from any facility. However, when it comes to the homeless, is this really truly enough?

Most discharge plans in homeless individuals include prescription medications they need to take, for which they likely don’t have the resources to acquire, let alone store and safeguard. For example, if the person has been issued insulin based on the diet they were receiving during hospitalization, this dosage may vary once they are discharged and lose their access to proper daily meals. Furthermore, these individuals seldom have the necessary tools to constantly monitor their blood sugar levels, among other things. Suffice to say, if they manage to acquire the insulin, but fail to maintain a proper diet, they are at an increased risk of insulin shock.

In this sense, a key to a successful discharge plan will depend heavily on the quality of the rapport established in the initial assessment, in order to truly understand the circumstances in which the patient is living. Through this information, the doctor will be able to design a treatment plan that the patient will be able to follow, so that their condition may improve, and through which they can keep their chronic diseases in check.