HME
Health Care of the Homeless
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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
HBsAg
xHCV Antibody
HIV Test
RPR (
Syphilis
Test)
Tuberculosis
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
Precautions
Medications
Avoid medications with risk of rebound if stopped
Beta Blocker
s
Clonidine
Avoid medications which predispose to
Heat Illness
or dehydration
Diuretic
s
Anticholinergic
s
Avoid medications that may potentiate
Drug Abuse
habit
See
Drugs of Abuse
Prevention
Immunization
s
Tetanus Vaccine
(
Tdap
or Td) every 10 years
Influenza Vaccine
Pneumococcal Vaccine
(if indicated)
Hepatitis B Vaccine
Complications
Adult
Relative Risk
s
Illness: 6x
Hospitalization: 4x
Early mortality (<52 years old): 3-4x
Trauma
tic
Head Injury
: 5x
Childhood
Relative Risk
s
Mortality under age 1 year: 9x
Illness: 4x
Delayed development: 4x
Delayed Growth
: 6x
Learning Disorder
s: 2x
Resources
Health Care for the Homeless
http://www.hchmd.org/resources.shtml
SAMHSA Homelessness Resource Center
http://homeless.samhsa.gov/default.aspx
National Center on Family Homelessness
http://familyhomelessness.org/
National Health Care for the Homeless Council
http://www.nhchc.org/
U.S. Dept of VA -
Veteran
Homeless Initiative
http://www.va.gov/homeless/
References
DuPlessis (2005) Pediatrics 115(4): 1095-100 [PubMed]
Maness (2014) Am Fam Physician 89(8): 634-40 [PubMed]
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