Disparities in health care access and utilization for individuals who are homeless

This research explored the health care needs of homeless men, women, and children in San Diego, California. There are currently over 15,000 homeless individuals annually in San Diego County, many of them in the downtown area. These individuals seek care from many providers. Little is known about their perception of their own health needs and wants, where and how they seek care, the problems they experience from fragmentation of care, their access-to-care issues, and their difficulty obtaining medication and follow-up care. Residents of shelter programs have improved access to health care and assistance with obtaining benefits to support that care, but the truly homeless have very little support. In this project, the focus was on interviewing homeless adults who used the Neal Good Day Center. These individuals were not in a shelter environment, and had access to this service center during daytime hours only. They lived on the street and frequently did not have any health care benefits or financial support. The goal of this research was to identify health care needs, health care access issues, and health care delivery problems, and develop a better understanding of health care disparities for this vulnerable population. Secondarily, health care is often planned and provided without input from the people being served, especially when the patients are from vulnerable populations; this research project gave participants a voice in the development and delivery of their own health care. Interviews were conducted on the streets near the Neal Good Center. An undergraduate nursing student/faculty member team participated in conducting interviews, performing data analysis, and presenting/publishing related to this research. A qualitative research approach using grounded theory methodology was the structure used to meet the goal of developing a grounded theory related to the process of obtaining and utilizing health care for a homeless individual or family. Barriers to access/utilization included many factors, with a general theme of “existing in the moment but losing ground over time.” This model can inform nursing education, practice, and research related to appropriate delivery of care to homeless adults.