Care For Homeless People Research Articles

Development of a foot care model to determine the risk of foot problems among homeless adults in Canada.

Foot care is a common problem for homeless adults in cities, who often receive fragmented foot care services, resulting in increased foot problems, health complications, hospitalisation, limb removal and disabilities. Among the health factors that negatively affect the homeless, foot health is essential, but often neglected. This study employed a descriptive, cross-sectional research design to assess the foot care of homeless people and develop recommendations for clinical practice. Using Inlow's 60-s foot screening method, the foot conditions of a purposive sample of 65 homeless adults were examined in British Columbia, Canada, in 2019-2020. Descriptive and inferential statistics were used to analyse the data. Determinants, such as sex and years of homelessness significantly contributed to homeless individuals' risk of developing foot problems. Differences in perceived and observed foot problems were influenced by equitable access to social health and healthcare services. Foot assessment is not well-covered by homeless health services and should be implemented as part of the standard medical review of homeless patients. Furthermore, foot assessment should be conducted by healthcare professionals, rather than relying on the standard practice of service users' self-report. Finally, foot care should be based on tailoring assessments and interventions for the individualised needs of homeless service users. Future research must seek ways to integrate homeless individuals' voices in the development, implementation and evaluation of foot care services.

COVID-19 and pandemic planning in the context of rural and remote homelessness

Addressing the vulnerability and unique needs of homeless populations during pandemics has been a major component of the Canadian federal response to the COVID-19 crisis. Rural and remote communities, however, have received little to no funding to aid in their care of homeless people during the pandemic. Similarly, there has been little to no research on rural communities’ pandemic preparedness in the context of homelessness. There are large numbers of homeless individuals in rural and remote Canada, including Indigenous peoples who are over-represented in homeless populations. Rural communities, including rural and remote Indigenous communities, are often isolated and more limited than urban areas in their capacity to respond to pandemics. They are particularly vulnerable due to fewer healthcare and social service resources—the lack of which has been particularly evident during the COVID-19 pandemic. In this commentary, we suggest that policy-makers need to take seriously the situation of rural homelessness in Canada, its implications for individual and community health, and consequences in the context of pandemics. Policy- and decision-makers can address these concerns through increased homelessness funding and support for rural and remote communities, policy change to recognize the unique challenges associated with rural pandemic planning and homelessness, and more research that can be translated into policy, programs, and supports for rural homelessness and pandemic planning response.

End-of-life care for homeless people in shelter-based nursing care settings: A retrospective record study

Background: Homeless people experience multiple health problems and early mortality. In the Netherlands, they can get shelter-based end-of-life care, but shelters are predominantly focused on temporary accommodation and recovery. Aim: To examine the characteristics of homeless people who reside at the end-of-life in shelter-based nursing care settings and the challenges in the end-of-life care provided to them. Design: A retrospective record study using both quantitative and qualitative analysis methods. Setting/participants: Two Dutch shelter-based nursing care settings. We included 61 homeless patients who died between 2009 and 2016. Results: Most patients had somatic (98%), psychiatric (84%) and addiction problems (90%). For 75% of the patients, the end of life was recognised and documented; this occurred 0–1253 days before death. For 26%, a palliative care team was consulted in the year before death. In the three months before death, 45% had at least three transitions, mainly to hospitals. Sixty-five percent of the patients died in the shelter, 27% in a hospital and 3% in a hospice. A quarter of all patients were known to have died alone. Documented care difficulties concerned continuity of care, social and environmental safety, patient–professional communication and medical-pharmacological alleviation of suffering. Conclusions: End-of-life care for homeless persons residing in shelter-based nursing care settings is characterised and challenged by comorbidities, uncertain prognoses, complicated social circumstances and many transitions to other settings. Multilevel end-of-life care improvements, including increased interdisciplinary collaboration, are needed to reduce transitions and suffering of this vulnerable population at the end of life.

Post-hospital medical respite care for homeless people in Denmark: a randomized controlled trial and cost-utility analysis

Being homeless entails higher mortality, morbidity, and prevalence of psychiatric diseases. This leads to more frequent and expensive use of health care services. Medical respite care enables an opportunity to recuperate after a hospitalization and has shown a positive effect on readmissions, but little is known about the cost-effectiveness of medical respite care for homeless people discharged from acute hospitalization. Therefore, the aim of the present study was to investigate the cost-effectiveness of a 2-week stay in post-hospital medical respite care. A randomized controlled trial and cost-utility analysis, from a societal perspective, was conducted between April 2014 and March 2016. Homeless people aged > 18 years with an acute admission were included from 10 different hospitals in the Capital Region of Denmark. The intervention group (n = 53) was offered a 2-week medical respite care stay at a Red Cross facility and the control group (n = 43) was discharged without any extra help (usual care), but with the opportunity to seek help in shelters and from street nurses and doctors in the municipalities. The primary outcome was the difference in health care costs 3 months following inclusion in the study. Secondary outcomes were change in health-related quality of life and health care costs 6 months following inclusion in the study. Data were collected through Danish registries, financial management systems in the municipalities and at the Red Cross, and by using the EQ-5D questionnaire. After 3 and 6 months, the intervention group had €4761 (p = 0.10) and €8515 (p = 0.04) lower costs than the control group, respectively. Crude costs at 3 months were €8448 and €13,553 for the intervention and control group respectively. The higher costs in the control group were mainly related to acute admissions. Both groups had minor quality-adjusted life year gains. This is the first randomized controlled trial to investigate the cost-effectiveness of a 2-week medical respite care stay for homeless people after hospitalization. The study showed that the intervention is cost-effective. Furthermore, this study illustrates that it is possible to perform research with satisfying follow-up with a target group that is hard to reach. ClinicalTrials.gov Identifier: NCT02649595.

Need for integrated care to homeless people in community

This paper focuses on marginalized clients who are often condemned for their lifestyle. Because of their way of life and community approach, they need help from several experts to solve their living or social situation. Interdisciplinary cooperation is therefore highly beneficial for the clients. However, it is more effective if integrated care exists in the community where these clients live. The aim of this paper is to find out the situation with the integrated care for homeless people in communities. We used semi-structured interviews. We interviewed 7 social workers who work with homeless people directly in the community where these clients live. We also discuss what experts are needed in this field, and we justify their necessity. Research results show that social workers' opinion is that integrated care directly in the community, where homeless people are, would be very helpful since homeless people are afraid to ask for services. Social workers would welcome if experts were willing to work with them directly with clients in the community. They also consider that their clients need hygiene centres and leisure activities. Conclusions – integrated care for homeless people is needed in communities. The results can serve as a description of integrated care in community to provide the best care for people who need their help.

Living on the streets: An integrative review about the care for homeless people.

To identify essential elements in care practices for the Homeless Persons in the context of Primary Health Care and verify evidence and strength of recommendation for health decision-making. Integrative literature review, using Health Descriptors, keywords and "MeSH terms" in the databases: LILACS, PubMed Centre and Web of Science. Twenty-two scientific papers were selected and grouped into three categories: Understanding of the Other, Support Network and Emancipatory Care. The study identified important elements for the development of care, such as understanding Homeless Persons, valuing network care and Emancipatory Care. There was a need for further studies and research on the subject, which would make it possible to construct more equitable and inclusive health policies and actions for this population that needs very unique elements in care practices.

A tuberculose na população em situação de rua: desempenho de profissionais da atenção primária

Objetivo: analisar as ações para o controle da tuberculose na população em situação de rua. Métodos: trata-se de uma pesquisa avaliativa que contou com a participação de 171 profissionais da estratégia saúde da família. Utilizou-se um instrumento que aborda aspectos da assistência à tuberculose para pessoas em situação de rua. A análise de desempenho ocorreu mediante avaliação das variáveis extraídas da análise fatorial exploratória e de confiabilidade. Resultados: no fator 1, ações para o controle da tuberculose na população em situação de rua, as variáveis foram classificadas como incipientes e parcialmente satisfatórias; no fator 2, apoio que as equipes devem receber para direcionar as ações de controle da tuberculose na população em situação de rua, as variáveis foram classificadas como insatisfatórias e incipientes. Conclusão: as ações para o controle da tuberculose na população em situação de rua não consideram as especificidades dessa população, contrariando as recomendações do Ministério da Saúde.

Challenges and potentialities of nursing work in street medical offices.

ABSTRACTObjective:to analyze elements of the nursing work process in the Street Medical Offices, highlighting the challenges and potentialities of care for homeless people. Method:this is an exploratory research of qualitative nature supported by the perspective of the health work process. The study was conducted through semi-structured interviews with nurses from the teams of the street medical offices at the city of Maceió and data were analyzed according to the content analysis technique, approaching issues related to the object, instruments and purposes of the nursing work process. Results:the identified themes were: Need for health care in the context of social and health vulnerability; Strategic planning and teamwork as tools for organizing the work process; Purposes and products of work: guaranteeing the right to access and care. . Before a work object designed by serious health needs resulting from the social vulnerability of this population, nurses use different instruments in their work process: strategic planning, acting in multiprofessional team and valorization of the light technologies of reception and bonding. Conclusion:apart from the difficulties, the study presents a successful experience that explores the potentiality of sharing relationships of humanized care.

Providing dedicated nursing care for homeless people

Providing dedicated nursing care for homeless people

Value of shared electronic health records for the management of homeless people

To assess the acceptability for GPS to use the French shared Electronic Health Record (Dossier Médical Partagé, "DMP") when caring for Homeless People (HP). Mixed, sequential, qualitative-quantitative study. The qualitative phase consisted of semi-structured interviews with GPs involved in the care of HP. During the quantitative phase, questionnaires were sent to 150 randomized GPs providing routine healthcare in Marseille. Social and practical acceptability was studied by means of a Likert Scale. 19 GPs were interviewed during the qualitative phase, and 105 GPs answered the questionnaire during the quantitative phase (response rate: 73%). GPs had a poor knowledge about DMP. More than half (52.5%) of GPs were likely to effectively use DMP for HP. GPs felt that the "DMP" could improve continuity, quality, and security of care for HP. They perceived greater benefits of the use the DMP for HP than for the general population, notably in terms of saving time (p = 0.03). However, GPs felt that HP were vulnerable and wanted to protect their patients; they worried about security of data storage. GPs identified specific barriers for HP to use DMP: most of them concerned practical access for HP to DMP (lack of social security card, or lack of tool for accessing internet). A shared electronic health record, such as the French DMP, could improve continuity of care for HP in France. GPs need to be better informed, and DMP functions need to be optimized and adapted to HP, so that it can be effectively used by GPs for HP.

Improving Health Care Management in Primary Care for Homeless People: A Literature Review.

Background: Homeless people have poorer health status than the general population. They need complex care management, because of associated medical troubles (somatic and psychiatric) and social difficulties. We aimed to describe the main characteristics of the primary care programs that take care of homeless people, and to identify which could be most relevant. Methods: We performed a literature review that included articles which described and evaluated primary care programs for homeless people. Results: Most of the programs presented a team-based approach, multidisciplinary and/or integrated care. They often proposed co-located services between somatic health services, mental health services and social support services. They also tried to answer to the specific needs of homeless people. Some characteristics of these programs were associated with significant positive outcomes: tailored primary care organizations, clinic orientation, multidisciplinary team-based models which included primary care physicians and clinic nurses, integration of social support, and engagement in the community’s health. Conclusions: Primary health care programs that aimed at taking care of the homeless people should emphasize a multidisciplinary approach and should consider an integrated (mental, somatic and social) care model.

PP95 Engagement Of Local Policymakers In HTA With Positive Results

Introduction:São Paulo city in Brazil has implemented social and health care for homeless people with pulmonary tuberculosis since 2007. We conducted a health technology assessment (HTA) of the interventions provided based on a national theoretical model using 2015 data and an overview of systematic reviews. The HTA was requested by national policymakers. The results demonstrated that the interventions for pulmonary tuberculosis were satisfactory. The municipal secretariat implemented actions to improve the national treatment recommendations and adopted incentives to increase adherence to treatments. Our objective was to describe the feedback process for the Health Secretariat.Methods:The feedback was categorized as: (i) an executive abstract with key messages (i.e. ninety-seven percent of notified cases underwent sputum smears, nineteen percent were hospitalized, and fifty-nine percent were cured) reported to policymakers involved in the surveillance program; and (ii) three meetings were organized jointly by the research group and local policymakers.Results:In 2016 we conducted a meeting to present the results. Thirty-nine professionals involved in the primary care team working on the streets (thirty-five percent) and the Tuberculosis Surveillance and Control Program (five percent) were present. The main barriers presented by the professionals were issues of human resources (i.e. suboptimal professional staff and having two different social organizations responsible for health care). The main facilitators presented by professionals were: (i) using homeless-peers as healthcare workers; (ii) having a network linking the primary care and surveillance programs; and (iii) periodic training.Conclusions:In addition to the positive results, the HTA presented an opportunity to discuss the sustainability of incentives for adhering to treatments adopted by the policymakers, such as meal allowances and housing support, to improve social conditions among the homeless.

Improving access and continuity of care for homeless people: how could general practitioners effectively contribute? Results from a mixed study

ObjectivesTo analyse the views of general practitioners (GPs) about how they can provide care to homeless people (HP) and to explore which measures could influence their views.DesignMixed-methods design (qualitative –>...

Vivência em Consultório na Rua do Rio de Janeiro: a situação de rua sob uma nova perspectiva

Objetivos: O presente relato tem como finalidade esclarecer como o Consultório na Rua utiliza-se da Redução de Danos para melhorar o cuidado à população em situação de rua, além de conscientizar profissionais da Atenção Primária à Saúde para as particularidades da população em questão. Métodos: Para tal, foi realizado estágio durante uma semana em um Consultório na Rua da cidade do Rio de Janeiro. Conclusão: Concluiu-se que a Redução de Danos é a principal estratégia para o cuidado adequado dos indivíduos em situação de rua, e que estes necessitam de uma abordagem biopsicossocial devido à sua complexidade e particularidades.

Who is left standing when the tide retreats? Negotiating hospital discharge and pathways of care for homeless people

Purpose – The critical potential of hospital discharge policies and practices to ameliorate the health and social care needs of homeless people has become the focus of considerable interest in England. Central to this rise in policy formation and practice development is an acute understanding of the multiple exclusions homeless people face in navigating public health and social care systems. In ways small and large this nascent landscape is serving to redefine and reshape hospital arrangements for homeless people, and opening-up new ways to deliver care across clinical, social and therapeutic boundaries. The purpose of this paper is to seek to add empirical vigour and theoretical rigour to this unfolding policy and practice terrain. Design/methodology/approach – This paper draws on findings from a case study concerned with exploring and explaining how statutory and voluntary sector organisations use specialist hospital discharge policies and practices to coordinate pathways of care for homeless people. Findings – This paper illustrates how people affected by homelessness and ill-health are routinely denied access to statutory housing support, social work assessments and district nursing provision through acts of institutional gatekeeping and professional abrogation. Originality/value – This paper makes an important contribution to understandings of the connections between hospital discharge arrangements for homeless people and statutory housing, social work and district nursing provision.

A Mobile Health Service to Manage Diabetic Foot in Homeless Patients.

Homeless people live in poverty, with limited access to public health services. They are likely to experience chronic medical conditions, such as diabetes mellitus; however, they do not always receive the necessary services to prevent complications. This study was designed to determine the effectiveness of a volunteer health service outreach to reduce disparity in diabetic foot care for homeless people. The research was conducted on 21 patients with diabetic ulcers of 930 homeless people visited between 2008 and 2013. Each ulcer was treated with regular medication every week for a mean ± SD of 17.6 ± 12 months. The inclusion criteria were 1) homeless with a previous diagnosis of diabetes or a blood glucose level greater than 126 mg/dL at first check and 2) foot ulcer caused by diabetic vasculopathy or neuropathy. The efficacy of the interventions was assessed against the number of successfully cured diabetic feet based on a reduced initial Wagner classification score for each ulcer. Clinical improvement was observed in 18 patients (86%), whose pathologic condition was completely resolved after 3 years and, therefore, no longer needed medication. One patient died of septic shock and kidney failure, and two patients needed amputation owing to clinical worsening of ulcers (Wagner class 4 at the last visit). Most homeless people who have diabetes and diabetic foot encounter many difficulties managing their disease, and a volunteer health-care unit could be a suitable option to bridge these gaps.

When dying at home is not an option: exploration of hostel staff views on palliative care for homeless people.

The Department of Health in the UK suggest that hostel staff are the most appropriate key workers for their dying homeless residents and that hostel-based palliative care may be the best way forward. However, little is known about the views of hostel staff with regard to this. Semi-structured qualitative interviews were conducted with seven participants from hostels distributed across three counties. A total of 37 specific case studies were discussed involving homeless residents with a wide range of life-limiting or palliative conditions. Eight main themes emerged: understanding palliative care; working with limited medical information; taking responsibility; building rapport; upholding residents' dignity; recognising physical deterioration; managing environmental challenges; role limitations and support needs of hostel staff. Discussion centred around the following four topics: policy, principles and practice of palliative care; professional boundaries as a threat to holism and a hindrance to dignity; the social undesirability and invisibility of homeless people; 'community living' as a barrier to hostel-based palliative care and a new concept of family.

Identifying standards to ensure seamless discharge to primary care for homeless people

Identifying standards to ensure seamless discharge to primary care for homeless people

Oral health care for homeless people

This article will explain some of the reasons people become homeless, their oral health needs and what the dental team can do to help

Outreach Work in Paris: A Moral Ethnography of Social Work and Nursing with Homeless People

How do we take care of homeless people? A field study with a humanitarian NGO, the Samusocial de Paris, France, gave the author the opportunity to observe nursing and social work with homeless people. The first part of the article recounts how the public problem of “grande exclusion” emerged in France and the kind of value judgments and controversies it gave rise to. He accounts for his tactics not to take sides for any of the definitions and evaluations available in the public sphere, and to deconstruct the genesis of the public policy of “social emergency” that was built in response to “grande exclusion”. The second part of the article keeps on drawing on pragmatism, shifting from Dewey’s The Public and its Problems (1927) to his Theory of Valuation (1939). It describes social work and nursing as moral and political activities. Care is not only given in face to face relationships, it is also a distributed and coordinated activity, embodied into situational arrangements, made of procedures, technologies, institutions, and people. The author shows how a moral ethnography of outreach work with homeless people gives new insights on the valuation operations performed by professionals on the field. It opens new perspectives in the analysis of situated ethics, in connection with a sociology of public problems and public policies.