Health Care While Homeless: Barriers, Facilitators, and the Lived Experiences of Homeless Individuals Accessing Health Care in a Canadian Regional Municipality

Abstract

Persons struggling with housing remain significantly disadvantaged when considering access to health care. Effective advocacy for their needs will require understanding the factors which impact their health care, and which of those most concern patients themselves. A qualitative descriptive study through the lens of a transformative framework was used to identify barriers and facilitators to accessing health care as perceived by people experiencing homelessness in the regional municipality of Niagara, Canada. In-person, semi-structured interviews with 16 participants were completed, and inductive thematic analysis identified nine barriers and eight facilitators. Barriers included affordability, challenges finding primary care, inadequacy of the psychiatric model, inappropriate management, lack of trust in health care providers, poor therapeutic relationships, systemic issues, and transportation and accessibility. Facilitators included accessibility of services, community health care outreach, positive relationships, and shelters coordinating health care. Knowledge of the direct experiences of marginalized individuals can help create new health policies and enhance the provision of clinical care.

Dental problems and chronic diseases in mentally ill homeless adults: a cross-sectional study

“…immune response contributing to oral disorders including DPs. It is also possible that the observed associations are due to the poor mental health status [51] combined with the disadvantaged socioeconomic conditions, social exclusion, systemic barriers, and enduring discrimination and stigma faced by homeless people [5,19,25,27,52], which increase their likelihood of having a neglected physical health status and higher burden of chronic comorbidities, including dental diseases.…”

“…Individuals who are homeless (those without a fixed, regular, and adequate night-time residence) had higher mortality rates and experience the dual burdens of DPs, CDs compared to the general population [4,5,14] due to structural and system-level barriers (e.g., lack of affordable housing, shrinking safety nets, health care systems models, health services affordability, lack of accessibility to health and social services) [15][16][17][18][19], social exclusion [18]. People experiencing homelessness frequently suffer serious mental disorders (e.g., psychotic disorders, mood and personality disorders, substance and alcohol use disorders) [20,21] and modifiable risk factors (e.g., diet, smoking) [22,23], which also contribute to poor health profiles and premature mortality [5,21].…”

Research priorities in healthcare of persons experiencing homelessness: outcomes of a national multi-disciplinary stakeholder discussion in the United Kingdom

“…PEH experience multiple barriers to accessing services including lack of knowledge, as well as the physical and mental capacity to prioritise healthcare and navigate services [8]. Perceived stigma and discrimination can deter PEH from using mainstream services [8,9].…”

Fixed Nodes of Transience: Narratives of Homelessness and Emergency Department Use

“…People who are homeless have reported feeling dehumanized in these interactions (Biederman & Nichols, 2014; Munoz, Aragon, & Fox, 2015), judged or disrespected because of their social position (Martins, 2008; McCabe, Macnee, & Anderson, 2001; Rae & Rees, 2015; Woith et al, 2017), and invisible to health care providers (Martins, 2008). Ramsay and colleagues (2019) reported that perceived prejudice by medical professionals discouraged the participants in their study from accessing health care. The interactions they reported evidenced examples of both “enacted” and “felt” stigma (Scambler, 2009, p. 445).…”

“…They also seek care at hospital emergency departments (EDs) at a commensurately higher rate than those with stable housing (Hwang et al, 2013; Ku et al, 2014; Kushel et al, 2001; Mandelberg, Kuhn, & Kohn, 2000). Some researchers have suggested that people who are homeless access the ED more frequently because factors associated with their lifestyle, such as their acute need for food and shelter or their lack of transportation, prevent them from obtaining preventive health care (Gelberg, Gallagher, Andersen, & Koegel, 1997; Ramsay, Hossain, Moore, Milo, & Brown, 2019); others have found that increased physical illness contributes to their greater ED use (Chambers et al, 2013; McCallum, 2019). Some have labeled this population’s pattern of ED use as “inappropriate,” concluding that they choose to access the ED for health needs normally addressed at primary care appointments (Ku et al, 2014; Wang et al, 2015), despite growing evidence that these claims of inappropriateness are inaccurate (Doran, 2016).…”