Vulnerable Populations. Poverty and Homelessness.

1. Vulnerable Populations. Poverty and Homelessness. By N.Haliyash MD, BSN International Nursing School TSMU

2. Objectives: • Define vulnerability • Describe vulnerable population groups • Analyze the effects of public policy on vulnerable populations. • Give examples of how a community health nurse might plan interventions for • vulnerable groups. • Analyze the concepts of poverty and homelessness. • Describe the social, political, cultural, and environmental factors that influence • Poverty. • Discuss community health nursing interventions for poor and homeless • individuals.

3. What is the definition of an aggregate? • "A vulnerable population group is a subgroup of the population who is more likely to develop health problems as a result of exposure to risk or to have worse outcomes from these health problems than the population as a whole."

4. The Type Of Outcomes • The type of outcomes that may be evaluated include: • Improved quality of life • Improved indicators of physical health status (B/p, skin integrity, mobility) • Reduced depression or anxiety • Improved functional status • Increased levels of knowledge about health behaviors

5. Vulnerable Populations: • Poor and Homeless • Health Care for the Homelessness Information Resource Center • Pregnant Adolescents • Migrant Workers • High Incidence of Tuberculosis in Migrant Workers • Severely Mentally Ill • Outcasts on Main Street • Substance Abusers • Details About Health Risks and Substance Abuse • Abused Individuals • Persons with Communicable Disease and Those at Risk • Persons with HIV

6. DID YOU KNOW??? • Referring clients to community agencies involves much more than simply picking up the phone and making a call or completing a form. You should be certain that the agency to which you are referring a client is the right one to meet the client's needs. • Nurses can do more harm than good by referring a stressed, discouraged client to an agency for which the client is not really eligible to receive services. Be sure to help the client learn how to get the most out of the referral.

7. PRINCIPLES FOR INTERVENING WITH VULNERABLE POPULATIONS Goals: • Set reasonable goals that are based on the baseline data you collected. Remember that many of the U.S. national health goals in Healthy People 2000 for special population groups are not set as high as those for the population as a whole to allow for realistic progress. Later, as baseline indicators improve, higher goal thresholds should be set. • Work toward setting manageable goals with the client. Goals that seem unattainable may be discouraging. • Set goals collaboratively with the client as the first step toward client empowerment. • Set family-centered, culturally sensitive goals.

8. INTERVENTIONS • Set up outreach and case-finding programs to help increase access to health services by vulnerable populations. • Do everything you can to minimize the "hassle factor" connected with the interventions you plan. Vulnerable groups do not have the extra energy, money or time to cope with unnecessary waits, complicated treatment plans, or confusion. As your client's advocate, you should identify what hassles may occur and develop ways to avoid them. For example, this might include providing comprehensive services during a single encounter, rather than asking the client to return for multiple visits.

9. EVALUATING OUTCOMES • It is often difficult for vulnerable clients to return for follow-up care. Help your client develop self-care strategies for evaluating outcomes. For example, teach homeless individuals how to read their own TB skin test, and give them a self-addressed , stamped card they can return by mail with the results. • Remember to evaluate outcomes in terms of the goals you have mutually agreed on with the client. For example, one outcome for a homeless person receiving isoniazid for TB might be that the person returned to the clinic daily for direct observation of the compliance with the drug therapy.

10. Poverty and Homelessness

11. Concept of Poverty: • shaped and influenced by personal beliefs, values, and knowledge of poverty: • Personal beliefs: ideas that are thought to be true • Values: ideas of life, customs, and ways of behaving that members of a society regard as desirable • Knowledge: an individual's known range of information • the life stories of those who experience poverty; and • social, political, cultural, and environmental factors.

12. Questions to tap into your own beliefs, values, and knowledge of poverty • 1. What do I believe to be true about being poor? • 2. What do I personally know about poverty? • 3. How have family and friends influenced my ideas and beliefs about being poor? • 4. Have I personally been poor • 5. What do I feel when I see a hungry child? A hungry adult?

13. Questions to tap into your own beliefs, values, and knowledge of poverty • 6. How has the media shaped my images of poverty? • 7. Do I think that people are poor because they just don't try to find work? Or does society have a significant influence on one's becoming poor? • 8. What causes poverty? • · What would I do if one of my homeless clients asks for change to get bus fare? • · What would I do in the home of an elderly client whose kitchen is covered in roaches? Where would I sit if he offers me a chair? • · While making a home visit in an especially unclean home, what do I do if the client asks me to eat something?

14. Conflicts in values, beliefs, and perceptions often arise when nurses work with persons from different social, cultural, and economic background. A lack of agreement between what professionals and clients see as a need can lead to conflict. As a result of this conflict, clients may fail to follow the prescribed treatment protocol; the nurse may then inaccurately interpret this behavior as resistance lack of cooperation, or noncompliance.

15. Nurses should evaluate clients in the context of their environment to develop nursing interventions that meet the needs of individuals, including those who live in poverty. • Treating medical problems alone is inadequate. • Instead, care must be multidimensional and biological, physiological, social, environmental, economic, and spiritual factors.

16. Social Factors: • Societal definitions of poverty vary depending on what source is consulted. • The difficulties of dealing with poverty and welfare reform are the lack of a common language and a common view. • People who are poor are more likely to live in dangerous environments, to work high-risk jobs, to eat less nutritious food, and to have multiple stressors. They often lack the tangible and emotional resources to manage expected crises because for them, managing their daily lives is a serious challenge.

17. The poverty thresholds • The poverty thresholds are issued by the U.S. Bureau of the Census and are used primarily for statistical purposes. • The poverty guidelines are issued by the U.S. department of Health and Human Services and are used to determine whether a person or family is financially eligible for assistance or services under particular federal program. • Many people who earn slightly more than the government-defined poverty levels are unable to meet living expenses and are not eligible for government assistance programs. • The people are often referred to as the near poor. • Persistent poverty refers to individuals and families who remain poor for long periods and pass poverty on to their descendants.

18. The poverty thresholds • Neighborhood poverty refers to spatially defined areas of high poverty and is characterized by dilapidated housing and high levels of unemployment. • Underclass poverty is defined as "the display of negative attitudes and behavior that are associated with poverty and indicate deviance from social norms." • If one asks the clients at Community Medical Care, they will tell you that being poor has less to do with money and more to do with a lack of family, friends, love, and support. What matters most is the nurse's ability to accept and respect clients and attempt to understand how their life situations influence their health and well being. • Being poor is one variable tat must be measured against the presence of other variables that may counteract the negative effects of poverty

19. Political factors: • A historical review reveals that poverty in the U.S. was not recognized as a social problem before the Civil War. The prevalent attitude was that poverty was an individual's problem, and individuals had only themselves to blame if they were poor. Generally, society did not believe it was responsible for alleviating the plight of the poor. • "The early interest in urban poverty research was not sustained, however, despite the heightened public awareness of poverty generated by the depression of the 1930s and the nationwide discussion and debate concerning the New Deal antipoverty programs."

20. Political factors: • "Aid to Dependent Children was enacted in 1935 as part of the Social Security Act to provide financial assistance to needy children under 16 years of age who were deprived of parental support because of death, incapacity or absence of a parent." • "In 1964 the War on Poverty was officially approved by Congress, with emphasis on job-training programs, and community participation and development." • The early 1990s saw an interest in both health care and welfare reforms; however, by the middle of the decade, little had been accomplished at the federal level. In contrast, states began making both health care and welfare reform changes, and the public sector, in an effort to control the costs of medical and hospital care, became a major driver of health care reform effort. • In 1994 a record 14.3 million people received welfare benefits, representing a 31% increase since the recession began in 1989.

21. Cultural Factors: • The meaning of poverty differs greatly by culture. Anglo cultures tend to view most aspects of poverty in a negative light.

22. Environmental factors: • In recent decades the number of adult and elderly Americans living in poverty has decreased while the number of women and children living in poverty has increased.

23. Reasons for the growing number of poor people in the United States: • Decreased earnings • Increased rates of unemployment • Changes in the labor force • More female-headed households • Inadequate education and job skills • Inadequate antipoverty programs • Low benefits from Aid to Families with Dependent Children (AFDC) • Weak child support enforcement • Dwindling Social Security payments to children • Increased proportion of births out of wedlock • As the economies in most industrialized nations have changed from an industrialized economy relying on manual labor to a service economy requiring highly skilled employees, job opportunities for people who do not compete at least high school are decreasing.

24. Poverty and Health: Impact Across the Lifespan: • The poor population has a higher rate of • chronic illness, • higher infant morbidity and mortality rates, • shorter life expectancy, • more complex health problems, and • greater physical limitations resulting from chronic disease. • These health care problems result from barriers that impede access to health care, such as inability to pay for health care, lack of insurance, geographical location, language, misdistribution of providers, transportation difficulties, inconvenient clinic hours, and attitudes of health care providers.

25. Childbearing Women: • Teenage women who are poor and who have below-average skills, regardless of their race, are 5.5 times more likely to have children than nonpoor teenage women.

26. Children: • One in five American children under age 18 and one in four children under age 6 are poor. As of 1993, the U.S. Bureau of the Census reported that 15.7 million children (or 22.7% live in poverty) • Poor teenagers are four times likely than nonpoor teens to have below-average academic skills.

27. Elderly: • The rate of poverty has decreased for the elderly population in the last 20 years. • As of 1993, the U.S. Bureau of the Census reported that 3.8 million Americans aged 65 and over live in poverty. • This decrease is primarily a result of improvements in Social Security and the Supplemental Security Income Program. • It is estimated that 35% of the homeless elderly persons are eligible for Social Security benefits, but only 4% access them.

28. Community and Poverty: • The poorer the neighborhood, the greater is the proportion of residents who are members of minority groups. • Family structure is most often a single parent with children. • In addition to the economic deterioration, residents of poor neighborhoods are more likely to be victims of crime, racial discrimination, and police brutality. • The rates of crime and substance abuse are higher in poor neighborhoods. • Differences in the quality of education in school and differences the level of education also exist. • Being poor is a health risk factor that should be assessed; however, nurses also need to examine individual and community strengths, resources, and sources of support.

29. WEB ACTIVITY 1: • Review the National Coalition for the Homeless Fact Sheets • http://nch.ari.net/facts.html • Why are People Homeless? • How Many People Experience Homelessness? • Who is Homeless? • The McKinney Act • What You Can Do

30. That’s all folks! Q & A ?