Opening Doors for the Homeless
NPs play lead role in Fairfax County program
Monday August 25, 2008
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Lori McLean, RN, MSN, FNP-BC
(Photo by Keith Weller)
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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.
To comment, e-mail editorDC@nursingspectrum.com.
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