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Health Care of the Homeless
Aka: Health Care of the Homeless, Homeless Person, Homelessness, Homeless Health Concerns- Definition: Homeless Person
- Individual without permanent housing
- No shelter in one third of cases
- Other transient shelters
- Living in vehicle or abandoned building
- Living in shelter or mission
- Living in constantly changing housing (e.g. moving between various family or friend's homes)
- Epidemiology
- Prevalence: 3 million in U.S. (1% of population) per year (0.6 Million on any given night in U.S.)
- At risk for Homelessness in case of single catastrophic event (no reserve): 46 Million in U.S. (14% of population)
- Homelessness lasts for days to weeks in most cases
- Families represent one third of cases
- Risk Factors
- Unstable job
- Low wage
- Veteran status
- Mental illness
- Physical Disability
- Inadequate access to affordable housing
- Inadequate access to affordable health care
- Inadequate to public assistance
- Alcohol Abuse
- Substance Abuse
- Domestic Violence
- Associated Conditions: Children
- Asthma
- Iron Deficiency Anemia
- Lead Poisoning
- Growth Delay
- Developmental Delay
- Learning Disorder
- Childhood Depression
- Childhood Anxiety
- Behavioral Disorders
- Child Abuse
- Associated Conditions: Adults
- Domestic Abuse (including sexual abuse, rape)
- Alcohol Abuse or Substance Abuse (20-30% of patients)
- Mental Illness (30-50% of patients)
- Schizophrenia
- Bipolar Disorder
- Major Depression
- Anxiety Disorder
- Post-Traumatic Stress Disorder
- Suicidality is common (especially <30 years old, hispanic, longer Homelessness duration, lower educational level)
- Infectious Disease
- Sexually Transmitted Disease (including HIV Infection)
- Tuberculosis
- Lice Infestation (risk of Bartonella infection such as Trench Fever, endocarditis)
- Scabies
- Foot infections, wounds and related disorders
- Cellulitis
- Pneumonia
- Uncontrolled or premature chronic disease
- Diabetes Mellitus
- Coronary Artery Disease
- Uncontrolled Hypertension
- Uncontrolled Hyperlipidemia
- Peripheral Vascular Disease
- Cancer risk (due to lack of routine cancer screening)
- Exposure related conditions
- Heat Illness
- Frostbite
- Hypothermia
- Immersion Foot
- Labs: Infectious Disease Screening
- Management
- Establish rapport with patient and family
- Provide accepting environment
- Establish trust
- Evaluate for significant health conditions
- See Associated Conditions above
- Develop evaluation and management plan
- Emergency contact
- Establish multidisciplinary approach to care
- Primary care
- Mental Health
- Social worker or case manager
- Future lab testing and other appointments
- Medications
- Follow-up plan
- Establish rapport with patient and family
- Precautions: Medications
- Avoid medications with risk of rebound if stopped
- Avoid medications which predispose to Heat Illness or dehydration
- Avoid medications that may potentiate Drug Abuse habit
- See Drugs of Abuse
- Prevention: Immunizations
- Tetanus Vaccine (Tdap or Td) every 10 years
- Influenza Vaccine
- Pneumococcal Vaccine (if indicated)
- Hepatitis B Vaccine
- Complications
- Adult Relative Risks
- Illness: 6x
- Hospitalization: 4x
- Early mortality (<52 years old): 3-4x
- Traumatic Head Injury: 5x
- Childhood Relative Risks
- Mortality under age 1 year: 9x
- Illness: 4x
- Delayed development: 4x
- Delayed Growth: 6x
- Learning Disorders: 2x
- Adult Relative Risks
- Resources
- Health Care for the Homeless
- SAMHSA Homelessness Resource Center
- National Center on Family Homelessness
- National Health Care for the Homeless Council
- U.S. Dept of VA - Veteran Homeless Initiative
- References