Homeless shelter residents and staff may be at higher risk of SARS-CoV-2 infection. However, SARS-CoV-2 infection estimates in this population have been reliant on cross-sectional or outbreak ...investigation data. We conducted routine surveillance and outbreak testing in 23 homeless shelters in King County, Washington, to estimate the occurrence of laboratory-confirmed SARS-CoV-2 infection and risk factors during 1 January 2020–31 May 2021. Symptom surveys and nasal swabs were collected for SARS-CoV-2 testing by RT-PCR for residents aged ≥3 months and staff. We collected 12,915 specimens from 2,930 unique participants. We identified 4.74 (95% CI 4.00–5.58) SARS-CoV-2 infections per 100 individuals (residents: 4.96, 95% CI 4.12–5.91; staff: 3.86, 95% CI 2.43–5.79). Most infections were asymptomatic at the time of detection (74%) and detected during routine surveillance (73%). Outbreak testing yielded higher test positivity than routine surveillance (2.7% versus 0.9%). Among those infected, residents were less likely to report symptoms than staff. Participants who were vaccinated against seasonal influenza and were current smokers had lower odds of having an infection detected. Active surveillance that includes SARS-CoV-2 testing of all persons is essential in ascertaining the true burden of SARS-CoV-2 infections among residents and staff of congregate settings.
To identify determinants that contribute to the length of homeless shelter stay.
We utilized a unique dataset from the Homeless Management Information Systems from Boston, Massachusetts, United ...States, which contains 44,197 shelter stays for 17,070 adults between Jan. 2014 and May 2018.
Our statistical analyses and regression model analyses show that factors that contribute to the length of a homeless shelter stay include being female, senior, disability, being Hispanic, or being Asian or Black African. A significant fraction of homeless shelter stays (76%) are experienced by individuals with at least one of three disabilities: physical disability, mental health issues, or substance use disorder. Recidivism also contributes to longer homeless shelter stays.
The results suggest possible program and policy implications. Several factors that contribute to longer homeless shelter stay, such as gender, age, disability, race, and ethnicity, may have funding implications. Age may point to the need for early interventions. Disability is developmental and may benefit from treatment and intervention. Finally, we find that length of stay and recidivism are not independent, and may form a vicious cycle that requires additional investigation.
Despite a great need for healthcare, unhoused individuals encounter significant barriers to utilizing public healthcare systems. Given the inequities in access to healthcare, accompanied by ...disabilities and health risks associated with homelessness, self-efficacy for self-care is particularly critical. As a primary purpose of this article, we describe a self-care intervention (Health Advocacy Behavioral Activation), which was implemented within a long-standing participatory community action research project for homeless shelters, and report evidence of the intervention's effectiveness in enhancing self-efficacy for self-care. Participants included 62 residents of the St. Vincent de Paul Gateway Shelter for Men (Dayton, Ohio). Shelter residents with disabilities and those without disability benefited approximately equally from the intervention and both showed statistically significant pre- to post-intervention improvements in self-efficacy for self-care. Recommendations for future research examining the effectiveness of the intervention are provided. As a secondary (supplementary) purpose, we report preliminary evidence of psychometric validation for a new instrument (Scale of Self-Efficacy for Self-Care), which was developed in service of our primary purpose (i.e., to examine the effects of intervention on self-efficacy for self-care) because a literature search did not identify an appropriate measure. Because this new instrument fills a void in the literature, we anticipate that it will be useful in practice and research, and so we delineate research recommendations for additional psychometric validation of this measure. Because of the barriers that unhoused people encounter with regard to access to healthcare in the community, self-care interventions provided (and evaluated) on-site (e.g., in homeless shelters) are necessary.
Abstract
Objective
Eye health among the homeless community is important, as poor vision makes this population vulnerable and adds significantly to the social and health burden. There is limited ...knowledge on patient follow-up rates for their eye conditions and barriers to accessing care in this population. The purpose of this retrospective chart review study is to examine follow-up rates and barriers to care for patients referred from a free, medical-student run ophthalmology clinic at a homeless shelter.
Methods
All patients evaluated at a free ophthalmology clinic from September 2017 to September 2018 were included; no patients were excluded. If indicated, patients were referred for advanced ophthalmologic care at a local county hospital and free eyeglasses at a nonprofit organization. Primary outcomes were follow-up rates at the county hospital and nonprofit organization. Secondary outcomes included prespecified baseline variables hypothesized to be associated with follow-up rates. These categorical variables were compared with Chi-square testing to determine their association with follow-up rates. The hypothesis being tested was formulated before data collection.
Results
Of the 68 patients, 84% were males with a mean age of 50 years. Overall, 40 patients were referred for free eyeglasses and 17 to the county hospital. Of those referred, 14 patients presented for free eyeglasses and 7 presented to the county hospital. About 79% of patients with a pre-established primary care provider presented to their appointment compared with 20% of those without one (
p
= 0.03). The 44% of patients with a high school diploma presented while all patients without a high school diploma failed to present (
p
= 0.04). Vision-threatening conditions identified at the shelter clinic did not affect follow-up rates (
p
= 0.79).
Conclusion
Less than half of referred patients in our study presented to their appointments. Barriers to presentation included no primary care provider and lower educational status, with no improvement in follow-up rates among those referred for vision-threatening conditions. Interventions such as health coaching with particular attention to educating patients on the effects of vision-threatening conditions may be warranted, particularly for those not looped into the health care system and those of lower educational attainment.
: After almost 30 years of Federal retraction from anti‐poverty initiatives, many American cities have been left with the dual burden of intensified poverty and far fewer resources to combat the ...problem. At the same time, such devolution has afforded cities the authority to forge poverty policy at the local level, such that the familiar neoliberal imperatives of state retraction and the mobilization of territory for capitalist expansion are frequently tempered by more progressive political imperatives at the local scale. What has thus emerged is a deeply ambivalent policy landscape, of which “kinder and gentler” poverty management strategies are a central feature. Using the example of a recent homeless program in San Francisco, “Care Not Cash”, this paper argues that such poverty management strategies, while less punitive than their revanchist predecessors, nonetheless introduce a new set of exclusions to the service delivery system, many of which are obscured by the language of compassion. In order to illustrate those new exclusions, I describe the city's homeless geographies—the public spaces, shelters, service sites, and housing models—that have been produced and reconfigured according to a logic of managing homelessness through the provision of care.
Homelessness and elder abuse are two major public health issues affecting older adults that are increasing in scope due to global population aging. While these issues have typically been examined ...separately, this commentary considers the often overlooked intersection between homeless older people and victims of elder abuse through two pathways: (1) the systemic abuse of older adults in the shelter system; and (2) the role of elder abuse as a possible risk factor for homelessness in later life. Strategies for the development of shelter systems that support the diverse needs of an aging population are proposed.
Worsening vision is a life-altering process that affects individuals in many aspects of daily life. While worsening vision can be caused by normal physiological processes that occur with age, there ...can be underlying systemic or ocular diseases that may be the root cause. Routine eye exams can screen for disease as well determine the degree of vision correction required to attain acceptable vision. Access to an eye exam ordinarily requires vision insurance and one must consider the added expense of glasses if they are recommended. While this can be a life-improving visit for many, there are several socioeconomic barriers that discourage homeless and low-income individuals from being able to access this service. The lack of resources to access regular eye exams and the resulting inadequate eye care may lead to underdiagnosis of serious ocular pathology. The Kansas City Free Eye Clinic is located inside a homeless shelter and, therefore, provides a convenient location for homeless and low-income individuals to receive comprehensive eye exams as well as prescription glasses at no cost. In this paper, we discuss the unique setup and demographics of this student-run eye clinic and the ways in which it has served the Kansas City population and how its integration into a homeless shelter could serve as a role model for free community eye clinics.
Homelessness is a public health issue that many organizations are addressing through a Housing First Model. One such organization is The Road Home (TRH), which provides services to homeless ...individuals and families in Salt Lake County. TRH is perhaps best known for their emergency shelters, but the organization also administers the Rapid Rehousing Program (RRHP), designed to help families experiencing homelessness transition back into stable housing. Those experiencing homelessness tend to have high rates of chronic mental/physical disabilities as well as issues related to substance abuse. Having a home is the first step toward achieving some kind of stability in their lives. The RRHP allows families to find housing in the private rental market and will cover the initial costs and several months of rent for clients. While the program has been praised by policymakers and social service providers for helping homeless families find rental housing, there is no empirical research about participant perspectives regarding their residential (in)security. The research question of this article is: what is the role of the RRHP in supporting the security of families experiencing homelessness? Researchers collected qualitative data through focus groups and interviews with 31 participants, 23 families experiencing homelessness, two landlords, six case managers, and service providers. Lastly, we identify recommendations for program improvements based on information gathered from research participants. It is our hope that the information presented in this article can and will be used in a way that improves public health by increasing the residential security of families experiencing homelessness.
The objective of this article is to analyse the situation of transformation of a victim's identity into a survivor's identity in mothers living in a shelter in Czech Republic. Domestic violence and ...commonly associated homelessness can be a very traumatic experience affecting the identity of homeless mothers. To understand victimological concept of reframing a victim into a survivor, we used analysis of data collected in qualitative participative research with 33 single mothers living with their children in shelters. The data shows that changing a victim's identity to a survivor's identity is realised in four stages that include: (1) the narratives of silence, (2) the narratives of total silence, (3) the narratives of transformation, and (4) the narratives of self-transcendence. An important element in the process of identity transformation is the relationship with the social worker. The results of the research are discussed in terms of relational psychoanalysis.
PDF
