Throughout my clinical experiences here at UNE, I have interacted with patients with various backgrounds and social determinants of health. In particular, one patient encounter showed me of how a person’s social determinants of health can negatively impact not only the access of care they are able to receive here in the U.S., but also influence the outcome of their admitting diagnosis.
The patient who I cared for was experiencing homelessness and also struggling with alcohol use. He had some neurological deficits, and his memory recall was limited. Due to his lack of access to health insurance, he did not have the ability to go to an inpatient rehab center for alcohol use and would relapse after discharge. The healthcare team knew this patient well. While they had a great rapport with him and they did their best to care for this patient with the resources they had, they knew he was not getting the full extent of the treatment he needed. Had he been able to access an inpatient treatment program for alcohol use, he would have received a more focused care plan to help him address his alcohol use, established better coping mechanisms, and subsequently the patient would have not had as many admissions to this unit. The fact that he was unable to access this kind of focused inpatient treatment prevented him from establishing and maintaining his basic needs: affordable housing, access to healthy meals, establishing employment, and receiving adequate emotional support. The limitations that this patient had due to his lack of health insurance, access to adequate care, and his experience with homelessness compounded his health issues and contributed to his health’s regression.
While I know the healthcare team was trying to help this person to the best of their ability, the health system that is in place makes it difficult for the patient population experiencing homelessness to surmount the many barriers that they face. The barriers such as health insurance affordability, adequate sustained housing, nutrition, emotional support, adequate clothing, transportation to the in network clinics, and transportation in general, all factor into these patient’s health. As I look at these factors, I realize that there is no simple answer; however, the community healthcare team could focus on small implementations to help address some of the health concerns that pertain to this population. These implementations could include: volunteer based regular pop-up health clinics at local shelters providing health screenings, dental care, fundamental supplies such as toothbrushes and toothpaste, hand sanitizer, travel first aid pack, socks, and blankets, education on alcohol and drug use including the Needle Exchange Initiative, resources for AA support groups, guidance on nutrition and local food pantries and soup kitchens, and information on local half-way houses. These implementations require the community’s support and willingness to be involved. This could be prompted by local municipal leaders and government, as well as further support from the state legislature identifying that there is a significant need for support of patients who are facing barriers to accessing adequate healthcare on a consistent basis.
While these implementations seem somewhat extensive or costly, applying any one of them is a small step towards addressing how we can increase the access to care for all. When I graduate from nursing school, I plan to be a part of the movement to improve the access to care by getting involved on a local level and advocating for vulnerable populations and the care they need.
