The document discusses common medical issues faced by those experiencing homelessness such as respiratory infections, skin problems, dental issues, hypertension, diabetes, asthma, peripheral vascular disease, allergies, seizures, and joint pain. It provides guidance on when to refer patients to primary care, clinics, or emergency rooms. The goal is to increase awareness of health issues in this population and ensure they receive appropriate medical care.
1. Common Medical
Issues For People
Who are Homeless
Ellen M. Brown, RN, LCSW
DHHS Program Manager
Health Care for Homeless
Danielle Jacques, RN, MSN
Community Health Nurse II
Health Care for the Homeless 1
2. Introduction
Today we’ll discuss
some common
medical problems
and the issues that
arise in providing
care to people who
are homeless.
We will also review
where to refer the
homeless for primary
medical care
2 2
3. Why is this important?
Studies show that 40% of
homeless suffer from one or more
chronic health problems
Chronic diseases among the
homeless are typically more
severe than in people who are
housed
The management of health
problems is more difficult in the
homeless.
3 3
4. Homeless
Homelessness can be
the cause of poor health
Poor health can lead to
homelessness
Homelessness makes
management of any
health problem more
difficult
Health
4
5. Objectives of this training:
Be aware of the major health
problems encountered among people
who are homeless
Gain knowledge into which clients
should go immediately to the
emergency room and which to refer
for an appointment with primary care
Be knowledgeable of the primary care
providers for homeless clients
5 5
6. The Top Ten Medical Conditions
1. Upper respiratory infection 2. Skin problems
3. Dental problems 4. Hypertension
5. Diabetes 6. Asthma
7. Peripheral vascular disease 8. Allergies
9. Seizures 10. Joint Pain
6 6
7. Upper Respiratory
Infection
Prevention is
important
Treatment is
encourage fluids,
take OTC meds,
and rest
Need to make sure
it’s not bronchitis,
pneumonia, or
allergies
7 7
8. Common Cold vs.
Serious Respiratory Infection
Routine visit Send to clinic Send to ER
ASAPend
Runny nose, Coughing up Breathing
Dry cough or sputum rapidly
small amt Normal Has high fever
sputum breathingCoughi Sudden onset
Gradual onset ng up Skin color not
normal
8 8
9. Skin Problems
Many kinds of skin
problems; most are
not contagious
Treat with creams
or occasionally
need oral meds
Watch out for lice
or scabies
9 9
10. Scabies
Caused by a mite,
Sarcoptes scabei
burrowing under
the skin
Causes severe
itching, especially
at night
Transmitted by skin
to skin contact,
very contagious
Treatment:
prescription cream
wash clothes in hot
water
10 10
11. Frostbite
Caused when tissues freeze
and ice crystals form and
rupture causing tissue death
3 stages
1st redness and pain
2nd blistering
3rd deep red/purple, hard
Treatment is re-warming
tissues and preventing
infection
DO NOT Burn the skin by
trying to reheat over an open
fire
DO NOT rub skin, this causes
further breakdown of tissues
11 11
12. Fungal Infections
Athlete's foot Can affect any part
of the body
Can be contagious
Often treated with
creams or other
“topical”
medications
Can take a long
time to resolve
Can be recurrent
12 12
13. Bacterial infections
Pus-filled blisters
(“pustules”) or
open wound
draining purulent
drainage
May have
swelling, redness,
warmth
13 13
14. Is it MRSA?
Methicillin Resistant Staphylococcus Aureus
Skin Infections
Transmitted by skin
to skin contact
Characterized by a
reddish rash with a
boil
Requires
aggressive
antibiotic therapy
14 14
15. Practice
‘Universal’ Precautions
Wash your hands often, carry
disposable hand wipes
Protect you hands from cracking
Wear gloves when handing
contaminated items
Cover open wounds and change
dressings when they are wet
Properly discard all contaminated
materials by double bagging
Clean soiled surfaces with a 1:10
bleach solution
15 15
16. Skin Problems
Routine visit Send to clinic Send to ER
ASAP
Bleeding stopped
Cut or sore: red Deep cut and
with pressure puffy bleeding not stopped
Human bite that with pressure
breaks skin Burn over large area
Small burn on top Itchy lesion with
layer of skin swelling, can’t breath
Itchy lesions that
Itchy lesion, wet with
don’t disturb sleep
blisters, trouble
sleeping
Open wound that is
draining
16 16
17. Dental Problems
Refer to primary
care for
infections then
dental clinic
May need
antibiotics
May need pain
meds
Need immediate
care if extra-oral
swelling occurs
17 17
18. Teeth/Mouth Problems
Routine visit Send to Clinic Send to ER
ASAP
Toothache Bleeding gums Bleeding gums and
Needs dental Tooth knocked out takes blood thinner
cleaning and doesn’t have it Tooth knocked out
Toothache with and has tooth
swelling, bleeding, Mouth sores-can’t
fever eat or drink
Swollen face, can’t
talk or can’t swallow
18 18
19. Hypertension (HTN)
HTN is elevated blood pressure
More common in the homeless
population than in the general
population
HTN is twice as prevalent in
alcoholics than in non-alcoholics
HTN may have no symptoms
Found on routine examination
HTN can be an emergency
19 19
20. Hypertension: The keys
to treatment
Try to avoid salt
Avoid alcohol and drugs
Take prescribed Medications
Monitor BP
HCTZ Verapamil
Lisinopril Atenolol
Clonidine
10/01/09 20 20
21. Heart and Circulation Problems
Routine Visit Send to Clinic Send to ER
ASAP
Running out of Shortness of Chest pain &
blood pressure breath with weakness,
pills in a few days movement or numbness
Running out of lifting Shortness of
blood thinner pills Is out of meds breath
in a few days Pale skin
Sweating
21 21
22. Diabetes
Symptoms may include excessive
urination, excessive thirst, fatigue
It is diagnosed through blood tests
Complications can include peripheral
neuropathy (loss of feeling in
extremities), kidney problems, eye
problems
22 22
23. Management of Diabetes
Clients need to monitor blood glucose with a
glucometer, primary medical provides them
May be controlled with diet (avoid sugar)
May need oral medication or insulin injections
Clients need to have regular, balanced
meals. Timing is important.
Dental and foot care is important
23 23
24. Diabetes
Routine visit Send to Clinic Send to ER
ASAP
Blood sugar less Blood sugar is Change in
than 120 and getting higher. mental status,
feels well. Is Increased with either high
taking meds urination. or low sugar
regularly. Out of meds.
Running out of
meds.
24 24
25. Asthma
A chronic inflammatory disease of
the airways
Prevalent in people experiencing
homelessness
Symptoms may include wheezing,
dry cough at night, tightness in
chest, especially when exercising
25 25
26. Management of Asthma
Inhalers
Oral meds
Control environment as
possible
Flu vaccine, pneumonia
vaccine
26 26
27. Asthma Triggers
Tobacco
Cold air
Perfume, paint, cleaning fluids
Allergens such as mites, pollen, cockroaches
Common cold, flu, other respiratory illness
27 27
28. Asthma
Routine visit Send to Clinic Send to ER
ASAP
Can breath OK if Trouble breathing Trouble breathing
uses inhaler Increased use of and unable to
Has enough “rescue” inhaler converse
meds/inhaler and More frequent Change in skin
is taking them coughing color
28 28
29. Peripheral Vascular
Disease (PVD)
Includes a broad group of
problems: chronic
edema, cellulitis of the
legs, phlebitis (blood
clots)
Prevalence is 10-15 times
greater than in general
population
High rates are related to
lifestyle: constant
walking, inability to
elevate feet during sleep
29 29
30. Cellulitis as a result of
PVD
Contributing factors:
Malnutrition
Lack of adequate rest
Exposure to the
elements
Limited access to
showers/hygiene
Psych issues/substance
abuse
30 30
31. Treatment of
Peripheral Vascular Disease
Elevate feet as much as possible
May use compression stockings or ace
bandages
Proper footwear
Patients with ulcers may need dressing changes
Infected wounds may need antibiotics
31 31
32. Peripheral Vascular Disease
Routine visit Send to Clinic Send to ER
ASAP
Swelling in feet Persistent Swelling of
or ankles by swelling of feet, feet, ankles,
the end of the ankles, legs legs with
day, goes shortness of
down in the AM breath or other
symptoms
32 32
33. Allergies
There are many
types of allergies
Possible symptoms
include sneezing,
watery eyes,
itching, skin rash or
hives, wheezing,
coughing, vomiting,
diarrhea, swelling
around the mouth…
33 33
34. Allergies
Rarely, an allergic
reaction can become life-
threatening.
“Anaphylaxis” may
begin with severe itching
of the eyes, and rapidly
progress to difficulty in
breathing and
swallowing, cramps, and
shock.
34 34
35. Management of Allergies
Oral antihistamine
medications
(Benadryl, Loratadine)
Skin creams
Nasal sprays
Control of
environment
35 35
36. Allergies
Routine visit Send to Clinic Send to ER
ASAP
Sneezing. Swelling of an Swelling of the
Rash but skin arm or leg face or throat
unbroken. Skin rash with Difficulty
excoriation. breathing or
Sneezing, swallowing
coughing Weakness
36 36
37. Seizures
This is most common neurological
illness in the homeless population.
The most common cause is alcohol
abuse, followed by head trauma.
There are many other causes.
37 37
38. What does a seizure look like?
Any of these:
Sudden falling
Passing out
Drooling, frothing at mouth
Grunting, snorting
Breathing stops temporarily
Uncontrollable muscle
spasms
Teeth clenching
Eye movements
Unusual behavior
Staring
38 38
39. Management of Seizures
Requires good relationship with a
primary medical care provider
Compliance with Medications
Controlling environmental factors
39 39
40. What to do if someone has a
seizure
Don’t panic
Keep him from hurting himself by easing
to the ground or positioning him safely
If possible, try to gently turn him on his
side
Tell someone to call 911
Note how long the seizure lasts
Don’t try to put anything in his mouth
When it’s over, have him rest
comfortably. Don’t try to move him right
away.
40 40
41. Seizures
Routine visit Send to Clinic Send to ER
ASAP
Takes seizure Is out of meds. Witnessed
meds but has Reports having seizure, esp. if
had no seizures. seizure for first time.
Prolonged
seizure.
41 41
42. Joint Pain
Back pain, hip pain, leg pain
very common
Made worse by walking,
sleeping on an uncomfortable
bed
May be a sign of more serious
disease
42 42
43. Joint Pain
Routine visit Send to Clinic Send to ER
ASAP
Past injury New injury that New injury.
causing is bruised, Bone is sticking out
discomfort; still swollen, and No feeling
has feeling, joint painful; still has Can’t move part of
can be used feeling, joint can body
be used Change in skin color
43 43
45. Flu Symptoms
Sudden onset of illness
Fever higher than 100.4
Chills
Cough
Headache
Sore throat
Stuffy nose
Muscle aches
Feeling of weakness and fatigue
Diarrhea, vomiting, stomach pain, esp in
children
45 45
46. “High Risk” Medical
Conditions Susceptible to
Flu
Pregnancy
Diabetes
Heart problems
Kidney Disease
Immunosuppression
Age over 65
Chronic lung disease
46 46
47. Is it flu or a common cold?
Influenza Common cold
Sudden fever, lasts 3-4 Fever is rare
days
Headache is common, Headache is rare
can be severe
Aches and pains are Aches and pains are rare
common and can be
severe
Fatigue is common and
Sometimes mild fatigue
can be severe
47 47
48. Is it flu or a common cold?
Influenza Common cold
Nausea, vomiting, Nausea,vomiting,
diarrhea in children, esp diarrhea are rare
< 5 years old
Watery eyes rare Watery eyes is common
Sneezing rare in early Sneezing is common
stage
Stuffy nose rare Stuffy nose is common
Chest discomfort Chest discomfort rare
common and can be
severe
48 48
49. Is it flu or a common cold?
Influenza Common Cold
Complications: Complications: Earache,
respiratory failure, congestion
worsening of chronic
conditions
Not fatal
Can be fatal
49 49
50. What to do for flu
Prevent spread of flu to others:
Wash hands
Dispose of tissues properly
Clean counters/surfaces with usual
products
Get a Flu Shot
If you get sick, rest, drink fluids,
and treat symptoms
50 50
51. Influenza
Routine visit Send to Clinic Send to ER
ASAP
Needs vaccine Underlying Shortness of
medical condition breath
Has had Poor color
symptoms for 5
days and no
better
51 51
52. Primary Medical Providers for
Homeless
Community Clinic Inc.
Serves uninsured men, women and children
Contracted with HHS for uninsured homeless adults
Participates with MA, PAC and Medicare
3 locations:
Gaithersburg Clinic
200 Girard St. Gaithersburg
301-216-0880 /Ride On #61
Silver Spring (Progress Place)
8210 Dixon St. Silver Spring
301-585-1250 / one block from SS Metro
Takoma Park
7676 New Hampshire Ave.
301-431-2972 / Ride On # 15, 16, 17, 18
52
53. Primary Medical Providers for
Homeless
Kaseman Clinic Inc.
Serves uninsured men and women
Contracted with HHS for uninsured homeless
women
Does not participate with any insurance
Kaseman Clinic
8 West Middle Lane, Rockville, MD
301-917-6800 /Ride On # 46
53
54. When you need help…
Call DHHS Health Care for the Homeless
Danielle Jacques, RN, MSN
240-777-3104 office
240-277-1003 cell
Ellen M. Brown, RN, LCSW-C
240-777-3963 office
240-380-7717 cell
The National Health Care for the Homeless Council
website: www.nhchc.org
54 54
Editor's Notes
Here are some good resources: The National Health Care for the Homeless