By: Mindy Barnes
According to Baggett, O’Connell, Singer, and Rigotti, it is a disappointing reality that, “[a]n estimated 2.3 to 3.5 million Americans experience homelessness each year” (2010, p. 1326). When it comes to their healthcare, many homeless people visit emergency rooms. Because social welfare programs are constantly being eliminated, emergency rooms are replacing these programs as the primary providers of healthcare for poverty stricken individuals. There is also high ER use among the homeless because most do not have health insurance, especially those with past year employment, and insurance is the key determinant of access to healthcare (Baggett, O’Connell, Singer, & Rigotti, 2010, p. 1329). Healthcare providers will need to address the many negative ways in which homelessness and poverty affect individuals. Such unfortunate impacts on the health and wellbeing of homeless men and women include:
1.It has been found that more than one half of the homeless population suffers from some form of mental illness. But because they lack money and insurance, they are not able to get the proper medication to help with their illness. (Baggett, et al., 2010, p. 1326)
2. This inability to access prescription medications for mental illness can also lead many down the path of drug and alcohol abuse, particularly as a form of self-medication. (Baggett, et al., 2010, p. 1326)
3. It has also been estimated that two thirds of homeless individuals have severe dental problems, and about 40% have vision impairments. (Baggett, et al., 2010, p. 1326)
4. Most individuals who are living in poverty, are also living in what are called “food deserts”. This means that they do not have access to good quality food, and are often forced to buy unhealthy food from convenience stores or fast food restaurants which can lead to obesity and other health problems. (Kelly Robertson, 02/23/16, Guest Lecture)
5. The population of homeless women is growing rapidly, and they are considered to be an extremely vulnerable population with higher rates of health problems than homeless men. Homeless women are more likely to be victims of physical violence and sexual assault, which can lead to bodily injuries or STDs. (Boes & van Wormer, 1997, p. 409)
Boes and van Wormer point out that, “[h]omeless people are at a greater risk for health problems than is the general public because of the harsh living conditions associated with being homeless and because of the inadequate system of health care delivery that is especially punitive toward people who have no health insurance (Belcher & DiBlasio, 1995)” (1997, p. 409). But it is also important to note that homeless individuals cannot be treated in the same way as the average patient. It is best for healthcare providers to take a social work approach when dealing with this extremely vulnerable population. One example of such an approach would be the strengths-oriented and feminist framework, which, “allows social workers to approach women’s needs both on a personal level and within the larger political and social context. In contrast to a diagnostic, pathology-based approach, social work practice from this framework looks beyond a client’s symptoms—for example, an unkempt appearance and suspicious demeanor—to positive qualities that can serve as an important resource even in the most desperate circumstances” (Boes & van Wormer, 1997, p. 410). This may include allowing the patient to shower, offering her (or him) a hot meal, and showing the individual unconditional kindness and support (Boes & van Wormer, 1997). Homelessness can happen to anyone, so it is important for healthcare providers and social workers alike to treat these individuals with the respect and compassion they deserve.
Baggett, T., O’Connell, J., Singer, D., & Rigotti, N. (2010). The Unmet Health Care Needs of Homeless Adults: A National Study. American Journal of Public Health, 1326-1333.
Boes, M., & van Wormer, K. (1997). Social Work with Homeless Women in Emergency Rooms: A Strengths-Feminist Perspective. Affilia, 12(4), 408-426.
Robertson, Kelly. February 23, 2016. Guest Lecture.