Missed Nursing Care of Unsheltered Populations

Morbidity and mortality among homeless populations in California continue to grow. Unsheltered individuals suffer from mental illness, physical disability, cognitive impairment, and acute and chronic illness. Many of these individuals qualify for care, yet encounters with nurses often miss these opportunities for care and referrals. We will examine the needs of a local homeless encampment in Southern California, to determine whether missed nursing contributed to their lack of access to health care resources.

Volunteers, licensed registered nurses, were trained for this project and consented to offer nursing care to a local unsheltered encampment. With oversight from the Institutional Review Board, data were collected in the camp to describe demographics and health care needs of those served.

The unsheltered population is disproportionate in representation compared with the community at large (21.2% Black vs. 6.4% representation in the greater community and 51% White versus 55.2% in the community at large). Of 236 participants included in the investigation, 33 (14%) had access to a case manager. Having an assigned case manager was significantly associated with access to shelter ( p = .019, φc 0.457), and more commonly associated with challenges in activities of daily living ( p = .011, φc 0.352). Most participants had a recent encounter (discharge within 1 month) with nursing (n = 20,134, or 56.8%).

This investigation offers concrete evidence of missed nursing care in unsheltered populations. In addition, access to a case manager was significantly associated with protection (access to shelter), a variable associated with better health outcomes.