Providing Health Care for the Homeless Is What These Nurses Do Best

Nurses should be front and center in providing care and improving health outcomes for homeless populations, according to Jillian J. Weber, PhD, RN, CNL, Homeless Patient Aligned Care Team (HPACT) National Program Manager, Homeless Programs Office, Veterans Health Administration (VHA).

Weber, who authored “A Systematic Review of Nurse-Led Interventions with Populations Experiencing Homelessness,” published January/February 2019 in Public Health Nursing, said the science demonstrates nurse-led models of health care for the homeless improve outcomes.

Jillian J. Weber, RN

“Studies show that nurse-led interventions effectively engage patients experiencing homelessness in positive health seeking behaviors, such as smoking cessation and medication adherence. Nurses effectively help patients reduce risky behaviors, including risky sexual behaviors and marijuana use. And nurse-led work with homeless populations has been shown to improve patients’ quality of life, overall,” Weber said.

The Growing Necessity of Health Care for the Homeless

The U.S. Department of Housing and Urban Development (HUD) estimates homelessness in terms of a point-in-time (PIT) count. The most recent published numbers from just before the pandemic in January 2020, showed 580,466 people experienced homelessness in the United States on a single night in 2020, a 2.2% increase from 2019.

The number of people who are homeless and living on the streets and other areas not suitable for living, compared to homeless people in shelters, was up 7%, according to HUD.

“Based on what we know about the pandemic — job loss, illness, eviction moratoriums expiring — the number of people facing homelessness in 2021 is likely to be higher,” Weber said.

People experiencing homelessness generally need a holistic approach to care, according to Weber. That includes addressing patients’ physical, mental, psychosocial and emotional needs. It involves thinking about the social determinants of health, including employment, hygiene, and barriers to access such as transportation, Weber continued.

“The nurse-managed health clinics that are utilizing holistic approaches to care were shown to improve patient satisfaction, reduce health-related costs, and increase access to care,” Weber said. “Putting RNs and advanced practice nurses in these clinics produces optimal health outcomes. They provide case management, advocacy, and the opportunities for patients to ask questions — leading to that openness that builds trust.”

Building trust is pivotal to successfully caring for these patients, said Patricia Obulaney, DNP, APRN, ANP-C, Clinical Associate Professor, University of Houston College of Nursing.

“It’s kind of like that saying, ‘If you build it [trust], they will come,’” said Obulaney, who runs the new University of Houston College of Nursing Health Clinic that serves homeless patients in Houston. “In the homeless community, patients need to know that we are going to be kind and respectful of them as individuals. Once trust is established, then you build rapport with patients and word gets out.”

Patricia Obulaney, APRN

Obulaney, an RN, and a receptionist staff the new University of Houston College of Nursing Health Clinic. Because nurse practitioners do not have full practice authority in Texas, there is a collaborating physician …read more

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