The Emergency Department Is The Unofficial Primary Care Facility For The Homeless

The lack of mental health services available to the mentally-ill and the deinstitutionalization of mental health hospitals have created a public health concern. These issues along with a failed continuum of care plans and a lack of community mental health services have been major contributing factors to homelessness. In addition, the strict guidelines for psychiatric hospitalization are critical when analyzing homelessness. In many cases, only the critically ill are meeting clinical criteria for hospitalization, leaving those who have significant mental health problems to fend for themselves. The link between homelessness and mental health is acknowledged but requires reform.

Homelessness has been a social problem for a long time so by trying to enable the individuals to gain access to the same health care as others it may prevent the amount of deaths of homeless people. It was found that just over a third of homeless person’s deaths were due to alcohol and drug misuse; if homeless individuals had access to a GP or health services they may be able to be referred and continuously reviewed to enable them to stop the substance misuse.

The homeless are a vulnerable population. They are defined by the U.S. Department of Health and Human Services as “an individual who lacks housing (without regard to whether the individual is a member of a family), including an individual whose primary residence during the night is a supervised public or private facility (e.g., shelters) that provides temporary living accommodations, and an individual who is a resident in transitional housing.” (The National Health Care for the Homeless Council, 2016). They are a social group throughout the US who are susceptible to all of the life’s cruelties. They are much more at risk for adverse illnesses due to their lack of available resources and medical help. Many have predetermined illnesses which need daily treatment but cannot acquire the medication needed. The homeless population lacks the funding for life’s necessities, thus the luxury of insurance and medicine is a dream.

Homelessness has become an evolving epidemic of our time, and the health implications associated with being homeless makes it that much worse. Homeless people are at major risk for premature death and a wide range of health problems such as HIV, skin blemishes, and much more. It is very difficult for homeless people to fix their health issues due to the difficulty of accessing health care possibly because of missing health cards, or simply because of the stigma placed on them when they enter a public facility. Whatever the problem may be that is forcing more people to become homeless, it must be solved, and quickly before our world turns into a travesty.

In the United States the homeless population continues to grow rapidly. Homelessness has been a public health issue for many decades. Often times these individuals feel as though society has turned a blind eye to them. This at risk population is seen by society as lazy or chose to live a life on the streets, but if one would examine this population closely would see that there is more to this at risk population than what society has labeled them as. The forces, which affect homelessness, are multifaceted. Social forces such as family breakdown, addictions, and mental illnesses are in combined with structural forces such as lack of low-cost housing, insufficient health services, and poor economic conditions. Many would

Income and social status is one of the determinants of health. Being able to have a secured, low cost housing that provides for every individual or family during their whole lifetime is a major determinant of health and is important to good health. As Dr. David Hulchanski and colleague’s research “Three Cities” at the University of Toronto stated; “Housing insecurity is linked to income insecurity which is, in turn, leads to illness and premature death” (RNAO,2013). People who live in the street are more susceptible to physical and mental problem and are likely to die early due to sickness compared to general population. Homeless population are vulnerable to communicable diseases and substance abuse and this may jeopardize their health situation (RNAO, 2013). Health conditions become better as income and social status improve. Higher income means the affordability of an individual for a better way of life and providing their family a safe and secured environment. Being able to afford enough nutritious food on the table to share with the whole family is one of the most important things that an individual can hope for. In most cases, higher income and social status means more control and choices in their everyday lives. Some studies show that restricted options and poor coping skills while handling stress raises exposure that can lead to different kinds of diseases involving immune and hormonal systems. According to

The most recent survey of homeless individuals conducted January 29, 2014 revealed 958 homeless adults with no dependants, 70 of which were completely unsheltered, and an additional 130 homeless adults who also had dependent children with them. 208 of these homeless adults are chronically homeless (HUD’s 2014 Continuum of Care Homeless Assistance Programs, Populations, and Subpopulations, 2014).Wayside Christian Mission reaches approximately 7,000 homeless individuals annually (Wayside Christian Mission, 2007). In the Journal of General Internal Medicine, a majority of homeless individuals surveyed stated that they felt discriminated against or that they received lesser care because of their poverty or homelessness (Wen, Hudak, & Hwang, 2007). Homeless and impoverished individuals suffer from high rates of depression, psychiatric illness, alcohol and or substance abuse, HIV/AIDS, TB, Trauma, preterm birth, COPD, low birth weight, musculoskeletal problems, decreased access to care, foot problems, malnutrition, and high Emergency Room utilization (Stanhope & Lancaster, 2014). Not only do homeless persons have a high rate of illness, but they are also less able to appropriately treat health problems. Many homeless individuals have limited access to care, cannot afford medications or nutritious food, and may have difficulty with managing a strict

There are currently 564,708 homeless individuals in the United States (U.S.), however this is just an estimate as there are probably hundreds that go uncounted, during PIT (point-in-time count) or remain unregistered with non-profit agencies providing services (The National Alliance to End Homelessness, 2016). Before the Affordable Care Act (ACA) most homeless individuals did not have health insurance, as provisions for these individuals as well as the low-income population could only be accepted into the Medi-cal / Medicaid program, if they had children that were eligible. Since ACA was implemented a large percentage of the homeless are insured, but, this does not mean that the preexisting gaps and barriers to access health care do not exist. They do. Being homeless has been found to correlate to a poor health status (Robert Wood Johnson Foundation, 2016). In fact, homeless individuals are at risk and experience more chronic illness than someone who has housing. Additionally, once chronic illness develops in a homeless individual, they are at higher risk for comorbid conditions, new conditions (such as skin disorders and respiratory illness) and an acceleration in the development of their disease(s).

The United States of America is the place known to many as the land of the free, home of the brave, and the place to start a better life. With any place that has good qualities, some have not so good qualities. The homeless population in the United States is at a staggering high, and many individuals are suffering because many lack employment/financial resources, housing resources, support from family and friends, and others negligence; such as natural disasters or fires. Homeless individuals may have no other choice than to live on the streets, trains, and alley ways to name a few places where homeless people seek shelter. The history of homelessness, social problems, demographics, common clinical

According to the American Journal of Public Health (AJPH), disease was prevalent in the newly homeless. This population accessed health care services at high rates in the year before becoming homeless. Significant improvements in health status were seen over the study period as well as a significant increase in the number who were insured (American Journal of Public Health, 2012). The homeless in Overtown face a variety of risks and barriers to their health. Firstly, a good number of the population suffers from mental illness, they suffer from a range of mental health problems from depression, personality disorders, schizophrenia and many more. Most are unable to treat their mental

Homelessness affects one fifth of the United States population (Hwang et al., 2010). The homeless population experience health conditions at higher rates than the general population and fifty percent of them are uninsured or lack access to health care services (Kar, Kumar, Singh, & Upadhyay, 2015). This study examine the homeless population and examines their level of health care utilization to demonstrate that homeless individuals are intensive users of health services. Tracing the sample population 's health care encounters is critical in and addressing the gaps they face in access to healthcare and understanding the importance of health access as a result of their vulnerable situations. The researchers discovered that homeless people with provincial health cards were accessing health services at high rates, specifically Emergency Department and inpatient hospital visits. Despite the study 's comprehensive assessment of high utilization of health services amongst homeless people, the study is limited by a biased sampling strategy that favored participants with valid provisional health card numbers, use of secondary data analysis, and generalizations due to minimal references to other cities in California. Strengthening

The social determinants of health are the conditions in which people are born, grow, live, work, and age (WHO, 2016). This current event relates to the social determinants of health because homelessness has a huge impact on someone’s overall health and quality of life. People who experience homelessness do not have the resources to maintain their health. This can lead to stress, depression, substance abuse, and a number of problems. They are exposed to communicable diseases, malnutrition and many other health issues. Over 500,000 Americans are homeless every night (Kertesz, 2016). This is why we have Health Care for the Homeless programs. The majority of federally funded organizations for the homeless are operated properly. But, there are some

Over the years Los Angeles has had the highest number of homeless people; this situation has been highly overlooked by media and political attention. Cities in many parts of the world may be known as centers for poverty whether if it 's a developed or developing country. No city, state, or country is prone to homelessness. Los Angeles in particular is an entry point for many immigrants who come to look for jobs. The intentions are not to cause there to be a vulnerability to poverty but to try to make a living some how. “Skid Row homeless population originates in South LA – where services and shelters lack resource adequacy and unemployment rates are high among adult men – and policy discussions rarely focus on this trend” (Howard, 4). Los Angeles Skid Row, is known to have the heaviest homeless population compared to other cities. Los Angeles does provide some homeless services like shelter and low-cost housing options for the poor but one of the issues that many homeless people come across is the lack of healthcare. Everyone can suffer from physical and mental health issues but there is a bigger impact on the homeless people in the Los Angeles county because they are not obtaining the proper help mentally, physically, and socially. Many people lose their lives or spread many disease amongst the community. The city of Los Angeles should provide healthcare for the homeless because this issue affects the homeless and everyone else around. More disease are passed around, more

Hi Maria, thank you for sharing this article regarding the initiative of the “Homeless Emergency Assessment & Response Team” (HEART) in San Francisco. I am very impressed that the HEART program is a collaboration between the San Francisco Fire Department and the Department of Public Health to provide non-911 or non-emergency care to the vulnerable residents in the city. As health care providers, we want to help everyone that is in need but in order to be cost effective; it is much better to provide the appropriate health care service in the correct situation. According to an article by Uscher-Pines, Pines, Kellermann, Gillen, and Mehrotra (2013), at least 30% of all ED visits in the United States were non-emergency visits. I believe the HEART

Throughout history there has always been a portion of society living in disadvantaged conditions. With the current high cost of living, global issues, unemployment rate on the rise, and low wages, many Americans are finding themselves homeless. One would think that in this advanced century, there would not be individuals living without the basic necessities such as food, water, and shelter. Unfortunately, there are millions of people with nowhere to sleep. Besides the many problems homeless people face daily, one of the leading problems is health care. Being homeless with limited access to health care or shelter in conjunction with mental illness or exposure to harmful diseases can lead to poor health, or