Introduction
Access to primary care is essential for the improvement of the health of people experiencing homelessness. Healthcare providers are uniquely placed to identify social contributors to ill health, such as limited access to food and income, and connect affected individuals to community-based service providers (Liu & Hwang, 2021). Homeless individuals depend entirely on emergency services given the fact that they face challenges that limit their access to primary care (Liu & Hwang,2021). It should be noted that this segment of the population experiences a higher rate of hospitalizations and emergency room visits than the general population (Liu & Hwang, 2021). The suboptimal nature of discharge planning that is experienced in most regions of the U.S. has been linked to a high rate of re-admission to health facilities (Liu & Hwang, 2021). The contextualization of challenges faced by vulnerable populations is essential for the delivery of quality healthcare services.
People Experiencing Homelessness
The North Carolina Interagency Council for Coordinating Homeless Programs (2018) estimates that at any given night, there are 9000 people experiencing homelessness, and a further 27,000 face similar conditions every year in North Carolina. The affected individuals live in the streets or in structures that are not suitable for human habitation. As of January 2018, 31% of homeless people in North Carolina were individuals in families with no children, 69% were adults with no offspring, 38% were female, and 62% were male (The North Carolina Interagency Council for Coordinating Homeless Programs, 2018). While efforts to improve service delivery to affected individuals are underway, this segment of the population experiences distinctive challenges that increase their vulnerability to disease.
Individuals experiencing homelessness face numerous mental, physical, and social obstacles that increase morbidity compared to the general population. The increased vulnerability in the identified population is due to the individual’s exposure to poverty, inhospitable living conditions, and structural barriers to care. Other factors include a high incidence of substance and alcohol abuse, high rates of tobacco consumption, and disproportionate discrimination (Liu & Hwang, 2021). The highlighted issues limit the affected population’s ability to access primary healthcare services.
Variables that Place People Experiencing Homelessness at Risk
Homeless individuals must contend with overwhelming structural barriers that impede access to healthcare. The lack of health insurance and financial challenges make accessing housing and essential services difficult (Liu & Hwang, 2021). The lack of health insurance means that homeless people have access to fewer therapeutic and diagnostic services. In addition, they face unaffordable healthcare bills, which worsen financial insecurity. It is often the case that people experiencing homelessness suffer the effects of avoidable complications associated with diseases because of their inability to access services. The shelter is essential in view of the fact that it provides privacy and safety from adverse weather conditions. It also acts as a space in which individuals can recover after an ailment or surgery. Limited access to habitable spaces increases the incidence of bad health outcomes among the homeless.
People experiencing homelessness must contend with competing priorities such as accessing food and shelter. The lives of homeless adults revolve around the search for food, safety, and shelter, which are deemed more important than issues involving their health. The economic challenges that characterize contemporary America have forced individuals without habitable homes to choose between accessing food or healthcare, with the former often being prioritized. As a result, individuals may suffer from curable illnesses for prolonged durations, thus increasing the incidence of complications and they underutilize essential preventive services.
Disproportionate experiences of discrimination often dissuade homeless people from accessing healthcare facilities. It is vital to note that professional relationships and encounters play a critical role in instances of isolation and homelessness. A study by Omerov et al. (2020) demonstrated that discrimination, alienation, and stigmatization had a deleterious effect on an individual’s well-being and willingness to seek healthcare services. Individuals experiencing homelessness are often in a fragile mental state, given the challenges they encounter (Omerov et al., 2020). It is vital to show compassion and respect to avoid instances where individuals avoid healthcare facilities, even when the services they require are available.
Health Risk
Substance abuse is a common health risk among people experiencing homelessness. The National Coalition for the Homeless notes that substance abuse is more prevalent in the vulnerable group compared to the general population (Mosel, 2022). According to Carver et al. (2020), affected individuals use drugs and alcohol as a way of coping with traumatic experiences or blocking troubling memories. The researchers also note that there is a strong correlation between drug overdose episodes and poverty (Carver et al., 2020). It is estimated that people experiencing homelessness have a higher risk of opioid overdose, with the risk rate indicated as 1.8% compared to 0.3% for low-income individuals with access to secure housing (Mosel, 2022). In addition, one-third of individuals in the population in question have challenges with alcohol, and two-thirds have suffered drug or alcohol use disorders in their lifetimes (Mosel, 2022). There is a need to address the high prevalence of substance abuse among people experiencing homelessness in North Carolina.
Healthy People 2030
The current opioid epidemic is among the factors that highlight the importance of instituting effective treatment for substance abuse disorders. One of the Healthy People 2030 program’s objectives is to “increase the proportion of people with a substance use disorder who got treatment” in the preceding year (U.S. Department of Health and Human Services, 2022, Para. 1). Only 11.1% of people older than 12 years of age who needed treatment for substance abuse accessed it at a specialty institution in 2018 (U.S. Department of Health and Human Services, 2022). Advanced nursing practitioners can implement specific strategies to increase the number of homeless people accessing treatment for substance abuse disorder through collaboration with local officials to advocate for people experiencing homelessness in North Carolina. The first strategy is advocating for policy changes in the local government. It is essential to collaborate with local government officials to prioritize the provision of screening services and community treatment resources, such as temporary and subsidized housing for homeless individuals diagnosed with substance abuse disorder. Such measures will ensure that the illness is contained, and the vulnerable population is protected from complications such as drug overdose.
Conclusion
People experiencing homelessness face numerous challenges that limit their access to essential healthcare. Overwhelming structural barriers, competing priorities, and disproportionate experiences of discrimination increase the incidence of bad health outcomes in the vulnerable population. As a result, many of the affected individuals suffer from substance abuse disorder and its related complications. It is essential to collaborate with local authorities to increase access to services and ensure that the well-being of people experiencing homelessness in North Carolina is protected.
References
Carver, H., Ring, N., Miler, J., & Parkes, T. (2020). What constitutes effective problematic substance use treatment from the perspective of people who are homeless? A systematic review and meta-ethnography. Harm Reduction Journal, 17(1), 1–22. Web.
Liu, M., & Hwang, S. W. (2021). Health care for homeless people. Nature Reviews Disease Primers, 7(1), 1–2. Web.
Mosel, S. (2022). Substance abuse & homelessness: Statistics & rehab treatment. American Addiction Centers. Web.
Omerov, P., Craftman, Å. G., Mattsson, E., & Klarare, A. (2020). Homeless persons’ experiences of health- and social care: A systematic integrative review. Health & Social Care in the Community, 28(1), 1–11. Web.
The North Carolina Interagency Council for Coordinating Homeless Programs. (2018). 2018 report of the North Carolina Interagency Council for Coordinating Homeless Programs. Web.
U.S. Department of Health and Human Services. (2022). Drug and Alcohol use: Increase the proportion of people with a substance use disorder who got treatment in the past year — SU‑01. Healthy People 2030. Web.