Summary
We began this chapter on Primary Care and Nursing by inviting you to think about health care as a key consideration related to understanding homelessness in Canada. Although we all have had our own experiences within the health care system, it is important to step back and consider other points of view.
At the start of the chapter, we introduced you to the composite character Tom, who was a 75-year-old widower experiencing homelessness who had a complex set of health issues. The scenario was presented as an entry point into thinking about the complexity of health care access and homelessness. We returned to Tom’s story again at the end to demonstrate how his experience can help us understand the foundational concepts of being trauma-informed, person-centred, socially inclusive, and situated within the social determinants of health as critical for understanding homelessness in Canada
We then asked you to consider three questions along the way, with the guidance of leading homelessness researchers.
First we asked, “Do people experiencing homelessness have equitable access to primary health care?”The answer here was a resounding no. We examined the social determinants of health as an explanation for why people experiencing homelessness are often in poor health. There are a range of barriers they encounter in seeking care including, but not limited to, discrimination within health care settings. We saw that mainstream health care is often inaccessible, so mobile outreach and shelter-based health care clinics are offered as alternatives. While these approaches have their benefits, they do not solve the underlying issue of inequitable primary care access. To change our system, we need dedicated Family Physicians and Nurse Practitioners treating clients with trauma-informed and socially-inclusive care practices, while also advocating for them on a broader scale within society.
Next we asked, “What specialized primary care would people who experience homelessness benefit from?” We began this section by considering a broad range of health conditions that are associated with homelessness, and we learned that while the clinical approach to treatment remains the same whether a patient is experiencing homelessness or is housed, the relational aspects of care are more complex. The need for tailored approaches was demonstrated through the clinical guidelines, consideration of transgender patients, and a case study on traumatic brain injury. Yet, while patient-centered care needs to be tailored to the individual’s needs, it is also critically important to remember that what everyone has in common is the need for health care that is welcoming, respectful, and accessible regardless of their housing status.
Finally, we asked, “Are there special end-of-life considerations for someone experiencing homelessness?” In the last section, we took a difficult look at how ideas about what constitutes a good death are challenged by homelessness. We began by reviewing the common causes of mortality, and how they contribute to premature death. Although palliative care is a fundamental human right, there is no unified national strategy at present, meaning that people living in homelessness or housing vulnerability may not receive the same level of care as those who have more financial resources. Measures such as advance care planning are important steps that can help provide a sense of dignity and hope at end-of-life by reaffirming the value of life and that one’s wishes will be respected after they are gone.
