The Health Impact Of Supportive Housing For Hiv Positive Homeless Patients : A Randomized Controlled Trial

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.

Cowan D & Marsh. 2001. A Two Steps Forward: Housing Policy into the New Millennium. Policy Press

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.

The United States government provides housing assistance for the elderly or disabled with low income statues through various programs in the form of rental assistance or affordable housing. However, most of these governments housing assistance for the disabled or elderly persons are managed through the local public housing authorities (PHAs). Several other agencies providing the same government benefits includes the local Department of Housing and Community Development, the individual State Housing Finance Agencies and the Rural Development offices through the U.S Department of Agriculture (USDA). Additionally, some financial aid channeled toward the housing assistance programs are retrieved from the U.S Department of Housing and Urban Development (HUD) as well as the USDA’s Rural Housing Services. Within this paper, several aspects of the housing policy for the disabled and the elderly persons will be delved into in brooder details.

Kalichman, Seth C., Lisa Belcher, Charsey Cherry, Ernestine A. Williams, Christopher T. Allers. 1997. “Human Immunodeficiency Virus (HIV) Seropositive Homeless Men.” Journal of Social Distress and the Homeless. 6(4): 303-318.

Many advocates and policymakers of housing for the poor believe that to achieve optimal human development of low-income households the location of the housing must be considered as well as the quality of the housing unit (Newman, 2008).

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 clinical issues affecting the homeless individual can range from mental illness to health issues. Several clinical issues affect the homeless population because of lack of health insurance and clinical resources. “The clinical issues affecting homeless people are dental, vision, foot diseases, post-traumatic arthritis, HIV, TB, STD’s respiratory infections, diabetes, hypertension, and nutritional problems are all major clinical issues” (Zevin, 2013). Quite a few people are homeless and suffer from various clinical issues because they have no insurance, housing, support from family/friends, or program resources. It seems when populations such homelessness is so huge some are left behind with no help. Various social service organizations exist that cater to the homeless population, but so many individuals and families are not helped because of mis-direction. Health care is an important factor to many, especially those who do not have access to a health care facility. Social services resources are available as well as the human service

Homelessness as a result of deinstitutionalization in the US increased dramatically, tripling in 182 cities over the court of the 1980s (Bagenstos, 2012). In addition, mental health and substance abuse is a major problem in across the country because of homelessness. According to the Substance Abuse and Mental Health Services Administration,20 to 25% of the homeless population in the United States suffers from some form of severe mental illness (DMHAS, 2014). Consequently, mental illnesses disrupt people’s ability to carry out key aspects of daily life, such as self-care and household responsibilities. As a result of these factors and the stresses of living with a mental disorder, people with mentally illnesses are much more likely to become homeless than the general population (Karger, & Stoesz, 2014). Even if homeless individuals with mental illnesses are provided with housing, they are unlikely to achieve residential stability and remain off the streets unless they have access to continued treatment and services. In Connecticut there are a number of housing options that are in place like supportive housing. Research has shown that supported housing is effective for people with mental illnesses (DMHAS, 2014). Unfortunately, in Connecticut, lack of funding is a significant barrier to the successful implementation of supported housing programs. Because of homelessness people cycle between street corner, jail cell and hospital beds, in addition the homeless who are

Homeless veterans seem to be a defenseless population by definition, as they are a subgroup in the population that is likely to have health problems or worse health challenges because of exposure to risks unlike the rest of the population. Many research undertaken to differentiate health problems linked to homeless veterans. They are vulnerable to co-morbidity of abuse of substances, mental, physical health infections and disorders than the common homeless population. Their inability to get or refuse treatment worsens their exposure to complications.

According to the 2012 Annual Homeless Assessment Report released by the Departments of Housing and Urban Development (HUD), an estimated 62,619 veterans were homeless on any given night in 2012. The good news is that the estimate represents a 7.2 percent decline from the 2011 estimate and a 17.2 percent decline compared to the 2009 estimate ("Veterans," 2013). Although progress is being made, there is much to be done. There are veterans with the same needs as the general homeless population, but also veterans with severe physical and mental health disabilities, related to their service, that necessitate permanent housing with supportive services.

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

The New York City Housing Authority (NYCHA) is the “largest public housing authority in the nation” (Developments, 2015). In existence since 1934 (About NYCHA: NYCHA at 70, 2015), NYCHA is a low to moderate income public housing initiative consisting of 328 developments throughout all five boroughs of New York City. More than 400,000 residents benefit from these developments through the receipt of not only apartments but additional services provided by each development and New York City overall. Over recent years the NYCHA developments have been experiencing a reduction in government funding, forcing the organization to re-evaluate strategies addressing maintenance of old buildings (About NYCHA, 2015).

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