Homeless Shelter Health Care Services

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Chong et al. (2014)	To estimate the health condition of the homeless population of Long Beach, CA	A convenience sample of 95 homeless persons residing in shelters of Long Beach (no comparison group)	A survey-based descriptive study of demographic factors, morbidities and comorbidities, and medical adherence	Level VI: evidence from a single descriptive study	Cardiovascular and psychiatric diseases could be witnessed most often, with no, one, two, or more comorbidities present. The medications were adequate to the cohort’s conditions. However, 30 and 47 percent of persons with cardiovascular and psychiatric disorders respectively were medically non-adherent	Small sample size; Survey-based on self-reported demographic and health conditions; No estimated duration of homelessness
Greysen et al. (2012)	To estimate the experience of homeless patients transitioned from medical institutions to shelters as related to the transition quality	A convenience sample of 98 homeless shelter customers visiting hospitals during their average 2.8 years of homelessness	A mixed-approach survey-based descriptivestudy of the quality of post-discharge transition from hospital to a homeless shelter	Level VI: evidence from a single descriptive study	The qualitative analysis revealed the coordination discrepancy between hospitals and shelter. Quantitatively, only an estimated 44% of the patients felt their housing needs were addressed	Small sample size; Participants recruited from a single community; Females and families were not addressed
Lynch et al. (2015)	To determine whether the Medical Home for Homeless Children Project (MHHCP) is sufficient in screening and treatment of homeless children	A cohort of children entering homeless shelters; N = 476, either fully (36%), partially, or not exposed to MHHCP screening tools during the study year (December 2011 to November 2012)	A case-controlstudy of the practical effects of medical services, with follow-up to estimate the cohort’s well-being	Level IV: evidence from a case-control study	Of 476 in total, 118 children underwent full screening. 50 were referred for mental care, of which 25 had completed the referral. These 25 are proof of the program’s efficiency since they would otherwise never receive mental care. Besides, the psychiatric profile of those who received the services was improved as compared to the rest of the cohort. Consequently, the program for nurse-led medical assessment in shelters is feasible	High level of shelter turnover in homeless families; Children’s mental health can be a matter of low priority to the parents
Wang et al. (2015)	To determine whether charity insurance and primary health care can reduce ED misuse among homeless patients	A cohort of homeless persons either covered or not covered with charity care insurance, with a total amount of 5,336 ED admission records	A retrospective cross-sectional study of the inappropriate ED usage in insured and non-insured groups of the homeless population	Level IV: evidence from a cross-sectional study	76% of ED visits in patients without charity insurance and approximately 77% of insured-patient visits were deemed inappropriate. Also, the primary care assignment did not prove to be a critical factor in reducing the misuse without other interventions, such as case management and pattern recognition	The data was retrieved from one institution; Duration of homelessness was not determined; Retrospective approach might result in insignificant bias as to the gathering and accuracy of the data

Author (year)

Purpose

Sample / Number of Participants

Design

Level of Evidence

Findings

Limitations

Summary

The research question addressed in the given summary table is whether homeless shelters should provide nursing and other medical services to their residents. The search for articles was based primarily on the issues they addressed: they all concern the issue of health care for homeless people and try to single out the most optimal models of it. The research question we try to answer requires a multidimensional perspective, which is why the articles overview the issue from diverse points.

The levels of evidence are necessary to consider when making a research since they are an undebatable cornerstone of evidence-based approach. Biases and unscrupulousness in evidence can mislead other researchers’ findings whereas a high-quality piece of evidence can provide a solid ground for further interpretation. Which is why two of the sources on this list have deployed control groups and are Level IV (Lynch et al., 2015; Wang et al., 2015). It does not necessarily mean that the other two sources are lower-quality since they are descriptive and are Level VI (Chong et al., 2014; Greysen, Allen, Lucas, Wang, & Rosenthal, 2012). They were chosen mainly because the findings presented are relevant and reflect the goal of the research. As for the designs, the studies use descriptive, case-control, and cross-sectional ones; again, the design of these studies does not determine their value.

Overall, the findings suggest that homelessness and healthcare are intertwined and make up a complicated issue. On the one hand, there are possibilities to address the problems concerning homeless health care and nursing. For example, it is estimated that a significant part of homeless with health issues and comorbidities are non-adherent to hospitals for whatever reason (Chong et al., 2014). In their turn, Greysen et al. (2012) find out that the majority of such patients do not feel hospitals meet their housing needs, with a significant part of them not adhering because they are forced back into the shelters immediately post-discharge. These results show there is a significant conflict between the homeless patients’ needs and how hospitals address them. On the other hand, the majority of homeless patients adhering to ED use it inappropriately, meaning their cases are either avoidable or non-emergency (Wang et al., 2015). By stating this, the authors of the research do not wish to put the blame on any of the parties involved; rather, their study demonstrates that the patients in question are under-educated about their opportunities. Speaking of which, there is a proof that nurse-guarded homeless health care can be implemented in shelters (Lynch et al., 2015). The results can at first appear insignificant and humble considering that homeless patients tend to move from one shelter to another which brings into question the whole idea of institutionalized nursing care, locally. Still, the concept of health screening appears perfectly utilizable. Nevertheless, the initial research issue formulated above cannot be answered directly, as yet. It can be estimated that the shelters are capable of providing health care services but whether they should do it remains questionable and requires additional literature study.

The sampling in all four sources appears adequate; every research team relied on what they could find and afford and selected their groups in accordance with their topics. In the first two sources the scope seems smallish which is why the findings should be interpreted cautiously. The study of ED admissions by Wang et al. (2015) provides the sample of more than 5,000 records – including recurrences – which is by far the most extensive one on our list. Because a bigger sample facilitates a more exact result, this source might be regarded as the most reliable here.

As to the limitations, all of the enlisted sources have them, as the majority of studies do. Because their sample size is smaller than the others’, the first two articles can be limited in terms of findings exactitude. In turn, the studies by Greysen et al. (2012) and Wang et al. (2015) use members of a single community or institution as their samples. Among other limitations there is the undetermined duration of homelessness status, failure to access gender diversity as a critical factor, and the patients’ self-assessment as a source of information. However, these limitations can be overcome in further studies by expanding the samples and scope, including gender and marital status as variables, and retrieving the information about homelessness status and health conditions from record databases.

All in all, the evidence we have found in these studies is not quite enough to take moves towards any changes at once. The main question that we have formulated above cannot be fully answered y what was discovered. So far, as the findings imply, it can be stated that rendering medical services in homeless shelters can prove beneficial for the vulnerable class of people. The reason is that the homeless are either not educated about their opportunities, and misuse them as a result, or not addressed by hospitals in terms of their housing needs. Medical care provided locally could assist those who would otherwise remain unassisted, as the studies have shown. Whether and how exactly the issue should be addressed to benefit all parties involved requires subsequent and more detailed research.

References

Chong, M. T., Yamaki, J., Harwood, M., d’Assalenaux, R., Rosenberg, E., Aruoma, O., & Bishayee, A. (2014). Assessing health conditions and medication use among the homeless community in Long Beach, California. Journal of Research in Pharmacy Practice, 3(2), 56-61.

Greysen, S. R., Allen, R., Lucas, G. I., Wang, E. A., & Rosenthal, M. S. (2012). Understanding Transitions in Care from Hospital to Homeless Shelter: A Mixed-Methods, Community-Based Participatory Approach. Journal of General Internal Medicine, 27(11), 1484-1491.

Lynch, S., Wood, J., Livingood, W., Smotherman, C., Goldhagen, J., & Wood, D. (2015). Feasibility of Shelter-Based Mental Health Screening for Homeless Children. Public Health Reports, 130(1), 43-47.

Wang, H., Nejtek, V. A., Zieger, D., Robinson R. D., Schrader C., Phariss C.,…Zenarosa, N. R. (2015). The Role of Charity Care and Primary Care Physician Assignment on Emergency Department Utilization in Homeless Patients. American Journal of Emergency Medicine, 33(8), 1006-1011.

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Homeless Shelter Health Care Services

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