Group Forums >> Psychiatric Nurses >> Homeless and Mentally Ill
Homeless and Mentally Ill
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Posted over 4 years ago
Opening Doors for the Homeless NPs play lead role in Fairfax County program By Christine Carlock, RN, BSN, MBA, DCH Monday August 25, 2008 Ray* is a 55-year-old diabetic who is homeless and in need of health care. Barriers to care, such as lack of insurance or transportation, present challenges to someone in Ray's situation. What is the best way to meet the healthcare needs of people such as Ray who don't have a medical home? Fairfax County, Va., came up with a solution, creating the nurse practitioner-led, multidisciplinary Homeless Healthcare Program about two years ago to serve the nearly 1,800 homeless persons living in the county. "This is the only health care some people will get," says Lori McLean, RN, MSN, FNP-BC, a nurse practitioner with the program. Nurses identify medical and mental health concerns while social experts satisfy patients' food, shelter, and clothing needs. The humane connection Locations where the homeless congregate serve as a catch point for initial contact with a healthcare professional. Fairfax County's family nurse practitioner travels with the hot meals van from FACETS – a local nonprofit group working with the homeless – and is always on the lookout for a new face. When spotting a potential patient, the nurse observes the person's behavior, watching for an unsteady gait, confused speech, offensive body odor, grooming deficits, or other signs of a medical condition. Nonjudgmental and respectful questions initiate the therapeutic relationship. The patient's perception of acceptance builds trust. A simple, nonthreatening question such as "How's it going?" may prompt dialogue that brings to light a health need. Ray may complain of excessive thirst and stomach pain, for example. With his consent, the nurse can take his blood pressure and share information about available county services, including clinic hours and locations, transportation options, or the location of shower facilities. The nurse may suggest he visit a county Community Healthcare Network clinic for a physical exam and offer transportation as an incentive. Collaboration of care Ray presents at the drop-in clinic and reveals he has diabetes but has not been taking his medication. A finger stick shows his glucose level is 280 mg/dL. The nurse orders an HgbA1c, chemistry panel, thyroid panel, and urinalysis to assess his tolerance to oral diabetic medications. With an established medical diagnosis, the county clinic becomes Ray's temporary medical home. Hearing Ray say he sometimes wishes diabetes would take him concerns the nurse. It prompts a referral to the psychiatric NP to evaluate whether Ray is a risk to himself or others, has feelings of worthlessness or guilt, or thought processes indicative of a psychiatric disorder. Ray's mental state is linked to his situational circumstances, and he is referred for outpatient follow-up with community-based mental health services. The county program moves patients eligible for Medicare, Medicaid, or Veterans Administration services to a permanent primary care provider. Sometimes, it could take a year for the patient to stabilize, build trust, and make that transition. "We're a conduit between no health care and no access, other than the emergency room, and getting them into a medical home," McLean says. * - Not the patient's real name. Christine Carlock, RN, BSN, MBA, DCH, is immunization coordinator for the Fairfax County (Va.) Health Department. American Academy of Nurse Practitioners. |
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| Posted over 4 years ago So here we go, some good news for a cahnge. Why can this not be done all over the country? |
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| Posted over 4 years ago Sounds very noble, this should be posted again at christmas. |
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| Posted over 4 years ago Nice to hear some good news for a cahnge
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| Posted over 4 years ago This is wonderful news and should be used as a guideline everywhere. Not everyone who is homeless is there by choice. There was a proposal in Chattanooga awhile back (2-3 years) to convert a nonused farmers market area into facilities for homeless people. There were also the usual protests ( probably by people who have a warm place to lay their heads at night) and some support. Didn't hear anything for awhile...as usual the almighty dollar stood in the way of perfection. Now that Volkswagen is coming to town, I saw where the homeless shelter is gearing up...again. Not to be too excited, though...more chatter against it, need money, etc. I feel as though someone thought it might be a good to revive the issue again, since so much money is being put into this Volkswagen venture...VW has said there will be no days allowed for inclement weather, etc. In other words, get off your dead ...and on your dying feet and let's get this thing done. Achtung??? Maybe w/ all the training they're going to provide, there will be interest in checking out the homeless to see where their talents lie. YEAH, RIGHT!!! Note to committee: Must keep homeless out of sight and widen the cracks for the few who haven't fallen through yet. I'm sure there are some homeless who already have issues w/depression, etc. And I'm sure there are some who are on their way to having mental and emotional issues (who wouldn't under these circumstances) but from what I hear and read, most if any assistance comes from volunteers and the ministry. I don't think there's any permanent program in place and God knows, there should be. A Proud Redneck Lovin' the Country Life |
