4.1 Defining poverty and homelessness

Poverty and homelessness are complex issues that significantly impact health and well-being. These conditions are characterized by lack of financial resources, stable housing, and access to basic necessities. Understanding the root causes and health risks is crucial for nurses providing care to vulnerable populations.

Nurses play a vital role in addressing the health needs of those experiencing poverty and homelessness. By recognizing barriers to healthcare and implementing strategies like housing first approaches and integrated services, nurses can help improve outcomes and advocate for systemic changes to promote health equity.

Defining poverty

• Poverty is a state of lacking sufficient financial resources to meet basic needs and maintain an adequate standard of living
• Poverty can have significant negative impacts on physical and mental health, education, and overall well-being
• Nurses play a critical role in understanding and addressing the health needs of individuals and families living in poverty

Absolute vs relative poverty

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• Absolute poverty refers to a fixed minimum level of income or resources needed to meet basic needs for survival (food, shelter, clothing)
• Relative poverty is defined in relation to the average standard of living in a particular society or community
  • Varies depending on the overall wealth and income distribution of the population
• Both absolute and relative poverty can have detrimental effects on health and access to healthcare

Poverty thresholds

• Poverty thresholds are the minimum income levels used to determine whether a household or individual is considered to be living in poverty
• In the United States, the Census Bureau sets poverty thresholds based on family size, composition, and income
  • As of 2021, the poverty threshold for a family of four was $26,500 per year
• Poverty thresholds are used to determine eligibility for various government assistance programs (Medicaid, SNAP)

Impact of poverty on health

• Poverty is associated with higher rates of chronic diseases (diabetes, heart disease, obesity)
• Individuals living in poverty often have limited access to preventive care, leading to delayed diagnosis and treatment
• Poverty can also contribute to poor mental health outcomes, including depression, anxiety, and stress
• Children growing up in poverty are more likely to experience developmental delays, behavioral problems, and lower educational attainment

Causes of poverty

• Poverty is a complex issue with multiple contributing factors at the individual, community, and societal levels
• Understanding the root causes of poverty is essential for developing effective interventions and policies to address health disparities
• Nurses can advocate for policies and programs that address the underlying social determinants of health and promote economic stability

Economic factors

• Lack of access to well-paying jobs and stable employment opportunities
• Low minimum wage and insufficient income to cover basic needs
• Globalization and outsourcing of jobs leading to loss of local industries
• Economic recessions and financial crises that disproportionately impact low-income communities

Social and cultural factors

• Systemic racism and discrimination that limit opportunities for education, employment, and wealth-building
• Intergenerational poverty and limited social mobility
• Lack of access to quality education and job training programs
• Cultural and linguistic barriers that hinder access to resources and services

Individual circumstances

• Single parenthood and lack of affordable childcare options
• Disability or chronic illness that limits ability to work
• Lack of transportation or reliable means to get to work
• Personal financial mismanagement or debt accumulation

Defining homelessness

• Homelessness is a complex social issue characterized by the lack of stable, safe, and adequate housing
• Homelessness can have significant negative impacts on physical and mental health, as well as social and economic well-being
• Nurses play a critical role in providing compassionate care and advocating for the needs of individuals experiencing homelessness

Categories of homelessness

• Unsheltered homelessness: living on the streets, in cars, or other places not meant for human habitation
• Sheltered homelessness: staying in emergency shelters, transitional housing, or other temporary accommodations
• Doubled-up or couch surfing: temporarily staying with friends, family, or acquaintances due to lack of permanent housing

Chronic vs episodic homelessness

• Chronic homelessness refers to individuals who have been continuously homeless for a year or more, or have experienced at least four episodes of homelessness in the past three years
  • Often have complex health needs and require intensive support services
• Episodic homelessness refers to individuals who experience occasional or short-term periods of homelessness
  • May be related to specific life events or crises (job loss, domestic violence)

Hidden homelessness

• Hidden homelessness refers to individuals who are not visibly homeless but lack stable, permanent housing
• Includes people living in motels, cars, or other temporary accommodations
• Often not captured in official homeless counts or statistics
• Can be particularly challenging to identify and provide services to

Causes of homelessness

• Homelessness is a complex issue with multiple contributing factors at the individual, community, and societal levels
• Understanding the root causes of homelessness is essential for developing effective interventions and policies to address the needs of this vulnerable population
• Nurses can advocate for policies and programs that address the underlying social determinants of health and promote housing stability

Lack of affordable housing

• Rising housing costs and limited supply of affordable rental units
• Gentrification and displacement of low-income communities
• Lack of public housing or subsidized housing options
• Barriers to accessing housing (criminal records, poor credit)

Unemployment and underemployment

• Loss of job or reduction in work hours leading to inability to pay rent
• Lack of living wage jobs and insufficient income to cover basic needs
• Barriers to employment (lack of education, skills, or transportation)
• Discrimination in hiring practices

Mental health and substance abuse

• Untreated mental health conditions (depression, schizophrenia) that impact ability to maintain housing
• Substance abuse disorders that contribute to financial instability and social isolation
• Lack of accessible and affordable mental health and addiction treatment services
• Stigma and discrimination associated with mental illness and substance abuse

Domestic violence and abuse

• Individuals fleeing abusive relationships often face housing instability
• Lack of affordable and safe housing options for survivors of domestic violence
• Fear of retaliation or further abuse from abuser
• Trauma and mental health impacts of abuse that hinder ability to maintain housing

Health risks of homelessness

• Homelessness is associated with a wide range of negative health outcomes and increased risk of morbidity and mortality
• Individuals experiencing homelessness often face barriers to accessing preventive care and managing chronic health conditions
• Nurses play a critical role in providing trauma-informed care and connecting individuals to needed health and social services

Chronic disease management

• Higher rates of chronic diseases (diabetes, hypertension, heart disease) among homeless populations
• Lack of access to regular primary care and disease management services
• Challenges with medication adherence and self-care due to unstable living conditions
• Increased risk of complications and hospitalization due to unmanaged chronic conditions

Infectious disease exposure

• Increased risk of communicable diseases (tuberculosis, hepatitis, HIV) due to overcrowded living conditions and limited access to hygiene facilities
• Lack of access to preventive care and early detection of infectious diseases
• Challenges with treatment adherence and follow-up care due to unstable living conditions
• Potential for outbreaks and spread of infectious diseases within homeless communities

Mental health challenges

• High rates of mental health conditions (depression, anxiety, PTSD) among homeless populations
• Exposure to trauma and chronic stress associated with homelessness
• Lack of access to mental health treatment and support services
• Stigma and discrimination associated with mental illness that hinder access to care

Substance abuse and addiction

• Higher rates of substance abuse disorders among homeless populations
• Use of substances as a coping mechanism for trauma and stress associated with homelessness
• Lack of access to addiction treatment and harm reduction services
• Increased risk of overdose and other health complications related to substance abuse

Barriers to healthcare for homeless

• Individuals experiencing homelessness face numerous barriers to accessing healthcare services, which can exacerbate existing health problems and lead to poor health outcomes
• Nurses can play a critical role in identifying and addressing these barriers, and advocating for policies and programs that promote health equity for homeless populations
• Providing trauma-informed, culturally competent care is essential for building trust and engaging individuals in needed health services

Lack of health insurance

• Many individuals experiencing homelessness are uninsured or underinsured
• Lack of insurance coverage limits access to preventive care, chronic disease management, and specialty services
• High out-of-pocket costs for healthcare services can be a significant barrier for individuals with limited financial resources
• Challenges with navigating complex health insurance systems and enrollment processes

Transportation and accessibility

• Lack of reliable transportation to healthcare appointments and services
• Difficulty keeping appointments due to competing priorities (finding food, shelter)
• Limited hours of operation for healthcare clinics and services that conflict with work or other obligations
• Physical barriers to accessing care (mobility limitations, lack of accessible facilities)

Stigma and discrimination

• Stigma and discrimination associated with homelessness can lead to negative experiences with healthcare providers and systems
• Lack of cultural competence and sensitivity among healthcare providers
• Fear of judgment or mistreatment that hinders individuals from seeking needed care
• Mistrust of healthcare systems and providers based on past negative experiences

Competing priorities for survival

• Individuals experiencing homelessness often prioritize basic needs (food, shelter, safety) over healthcare
• Lack of stable housing and food insecurity can make it difficult to prioritize health and attend appointments
• Challenges with managing medications and self-care while experiencing homelessness
• Limited bandwidth and energy to navigate complex healthcare systems and bureaucracies

Strategies to address homelessness

• Addressing homelessness requires a comprehensive, multi-sectoral approach that addresses the root causes of housing instability and promotes long-term solutions
• Nurses can play a critical role in advocating for policies and programs that address the social determinants of health and promote housing stability
• Collaborating with community partners and leveraging existing resources is essential for developing effective interventions and supports for individuals experiencing homelessness

Housing first approach

• Prioritizes providing permanent, affordable housing as quickly as possible, without preconditions or barriers
• Recognizes that stable housing is a foundation for improving health and well-being
• Provides wraparound support services (healthcare, mental health, substance abuse treatment) to help individuals maintain housing stability
• Evidence-based approach that has been shown to improve health outcomes and reduce healthcare costs

Supportive housing programs

• Combines affordable housing with on-site support services (case management, mental health treatment, substance abuse counseling)
• Targets individuals with complex health and social needs who require intensive support to maintain housing stability
• Provides a safe, stable environment for individuals to address underlying health and social challenges
• Has been shown to improve health outcomes, reduce hospitalizations, and decrease overall healthcare costs

Integrated healthcare services

• Co-locates primary care, mental health, and substance abuse treatment services in a single setting
• Provides a one-stop-shop for individuals to access comprehensive healthcare services
• Promotes care coordination and communication among healthcare providers
• Reduces barriers to accessing care and improves engagement in needed health services

Community outreach and engagement

• Involves actively reaching out to individuals experiencing homelessness in their communities (street outreach, mobile health clinics)
• Builds trust and relationships with individuals who may be hesitant to engage with traditional healthcare systems
• Provides low-barrier, trauma-informed care that meets individuals where they are at
• Connects individuals to needed health and social services, and helps navigate complex systems and bureaucracies