👨‍⚕️Nursing Care of Vulnerable Populations Unit 4 – Poverty & Homelessness in Vulnerable Populations

Key Concepts and Definitions

• Poverty involves a lack of financial resources to meet basic needs (food, shelter, healthcare)
• Absolute poverty refers to a set standard which is consistent over time and between countries
  • Measures poverty in relation to the amount of money necessary to meet basic needs
• Relative poverty views poverty as socially defined and dependent on social context
  • Compares the lowest segments of a population with upper segments
• Homelessness is a condition where an individual lacks a fixed, regular, and adequate nighttime residence
• Chronic homelessness refers to being continuously homeless for at least one year or having at least four episodes of homelessness in the past three years
• Housing insecurity includes a broad set of challenges (overcrowding, poor housing quality, unstable neighborhoods, inability to pay rent)
• Social determinants of health are conditions in the environments where people live, learn, work, and play that affect a wide range of health risks and outcomes

Causes and Risk Factors

• Unemployment and underemployment lead to financial instability and inability to afford housing
• Lack of affordable housing options, particularly in urban areas with high costs of living
• Mental health disorders, such as depression, bipolar disorder, and schizophrenia, can make it difficult to maintain stable employment and housing
• Substance abuse disorders can lead to financial instability, job loss, and difficulty maintaining housing
• Domestic violence can force individuals, particularly women and children, to flee their homes and become homeless
• Incarceration history can make it difficult to secure employment and housing upon release
• Aging out of the foster care system without adequate support can lead to homelessness
• Discrimination based on race, ethnicity, sexual orientation, gender identity, and disability can limit access to housing and employment opportunities

Demographics and Statistics

• In 2020, 37.2 million people in the United States lived in poverty (11.4% of the population)
• Poverty rates are highest among racial and ethnic minorities (19.5% for Black individuals, 17% for Hispanic individuals)
• Women are more likely to experience poverty than men (12.6% compared to 10.2%)
• Children have a higher poverty rate (16.1%) compared to adults aged 18-64 (10.4%) and those 65 and older (9%)
• On a single night in January 2020, 580,466 people experienced homelessness in the United States
• 70% of homeless individuals are men, while 30% are women
• 39% of the homeless population are Black, despite making up only 13% of the general population
• 6% of homeless individuals are veterans

Health Impacts and Challenges

• Poverty and homelessness can lead to increased risk of chronic diseases (diabetes, heart disease, respiratory conditions)
• Limited access to preventive care and early detection screenings can result in delayed diagnoses and poorer health outcomes
• Inadequate nutrition due to food insecurity can lead to malnutrition, obesity, and related health problems
• Exposure to extreme weather conditions and unsanitary living environments can cause hypothermia, heat stroke, and infectious diseases
• Mental health disorders, such as depression and anxiety, are more prevalent among individuals experiencing poverty and homelessness
  • Lack of access to mental health services can exacerbate these conditions
• Substance abuse disorders are more common among homeless populations, often as a coping mechanism for stress and trauma
• Barriers to accessing healthcare services include lack of insurance, transportation difficulties, and stigma associated with poverty and homelessness

Social and Economic Implications

• Poverty and homelessness can perpetuate a cycle of intergenerational disadvantage, limiting opportunities for education and upward mobility
• Children growing up in poverty may have limited access to quality education, leading to lower academic achievement and reduced future earning potential
• Homelessness can disrupt social networks and support systems, leading to isolation and difficulty maintaining relationships
• Stigma and discrimination associated with poverty and homelessness can lead to social exclusion and reduced access to resources and opportunities
• Individuals experiencing poverty and homelessness may have difficulty securing and maintaining employment due to lack of stable housing, transportation, and access to necessary resources (clothing, hygiene facilities)
• The economic burden of poverty and homelessness on society includes increased healthcare costs, reduced productivity, and the cost of social services and interventions

Nursing Assessment and Interventions

• Assess for social determinants of health, including housing status, income, employment, and access to healthcare
• Screen for chronic diseases, mental health disorders, and substance abuse disorders that may be more prevalent among individuals experiencing poverty and homelessness
• Provide patient education on disease management, medication adherence, and preventive care, taking into account potential barriers to access and health literacy
• Connect patients with community resources, such as housing assistance programs, food banks, and job training services
• Collaborate with social workers and case managers to develop comprehensive care plans that address both medical and social needs
• Advocate for policies and programs that address the root causes of poverty and homelessness, such as affordable housing initiatives and living wage laws
• Provide trauma-informed care, recognizing the impact of adverse experiences on health and well-being
• Establish trust and rapport with patients, creating a non-judgmental and supportive environment that encourages engagement with healthcare services

Community Resources and Support Systems

• Housing assistance programs, such as public housing, Section 8 vouchers, and rapid rehousing initiatives, can help individuals secure stable and affordable housing
• Food banks and meal programs provide access to nutritious food for individuals and families experiencing food insecurity
• Job training and employment assistance programs can help individuals develop skills and secure stable employment
• Mental health and substance abuse treatment services, including counseling, support groups, and medication-assisted treatment, can address the unique needs of individuals experiencing poverty and homelessness
• Case management services can help coordinate care and connect individuals with necessary resources and support systems
• Homeless shelters and drop-in centers provide temporary housing, basic necessities, and access to services for individuals experiencing homelessness
• Legal aid services can assist with issues related to housing, employment, and public benefits
• Peer support programs connect individuals with others who have experienced similar challenges, providing emotional support and practical guidance

Ethical Considerations and Advocacy

• Nurses have a moral and ethical obligation to provide compassionate, non-discriminatory care to all patients, regardless of their socioeconomic status or housing situation
• Advocating for policies and programs that address the social determinants of health is essential to promoting health equity and reducing disparities
• Nurses should be aware of their own biases and work to create an inclusive and welcoming healthcare environment for all patients
• Protecting patient privacy and confidentiality is crucial, particularly for individuals experiencing poverty and homelessness who may face stigma and discrimination
• Collaborating with community partners and stakeholders can help create a more coordinated and effective response to the complex needs of individuals experiencing poverty and homelessness
• Nurses can engage in research and data collection to better understand the health needs of vulnerable populations and inform evidence-based interventions
• Promoting cultural competence and humility can help nurses provide care that is responsive to the diverse needs and experiences of individuals experiencing poverty and homelessness
• Advocating for policies that address the root causes of poverty and homelessness, such as affordable housing, living wages, and access to education and healthcare, is essential to creating long-term, sustainable solutions