Federal policy for homeless healthcare accessibility and cultural competence

Homelessness and Healthcare Disparities Homelessness: Population and Policy Considerations
At around half a million in the United States, the homeless population represents a fairly substantial population comprised of diverse individuals (Stevenson & Purpuro, 2018). The main factor shared in common among the heterogeneous homeless population is uniformly high vulnerability to mental and physical health issues as well as to sexual and physical abuse. Of course, the mortality risks among the homeless population is also elevated. Making matters worse is the fact that the homeless population suffers greater than average barriers to accessing healthcare services and there are relatively few policies or programs that make up for the disparities and risks endured by the homeless population (Elwell-Sutton, Fok, Albanese, et al., 2016). While policies and programs addressing the multifaceted problems related to homelessness do exist, there are few policies that provide a comprehensive, systematic, uniform solution to address healthcare access disparities.
At the federal level, such a policy would provide the theoretical or philosophical framework that could guide state-specific or municipality-specific programs and services with value-driven solutions. A policy for minimizing access disparities for the homeless population would serve many interrelated needs, not least of which would be reducing the cost burden associated with homelessness to begin with. Having unresolved healthcare issues—mental or physical—can become such a tremendous financial and psychological burden that it leads to or exacerbates risks for homelessness. Being unable to access healthcare services at the early stages of a problem creates more costly and more severe consequences later on. Therefore, a federal policy that addressed healthcare accessibility would reduce burdens on the healthcare system as well as burdens on all human service programs. Outcomes A proposed policy for addressing the pervasive and detrimental healthcare access disparities for the homeless population fulfills several needs, which can be expressed as measurable outcomes. The primary need is to improve health service accessibility through a principled caring healthcare culture. “Homeless people sometimes perceive healthcare providers as uncompassionate, disrespectful, and untrustworthy,” (Stevenson & Purpuro, 2018, p. 62). Therefore, healthcare organizational culture does need to address this issue systematically via concrete strategies for human resource development, outreach services, and advocacy networks. Measurable outcomes for this organizational culture construct would be linked to surveys, which can quantify population perceptions of healthcare services. For instance, Gollust, Cunningham, Bokhour, et al. (2018) claim that healthcare providers operate with “unconscious biases,” which adversely affect health outcomes as well as raise barriers to accessing healthcare services (p. 1). Survey data would help reveal which methods are working best to increase healthcare service accessibility.
A related policy need would be to incorporate diversity considerations when working with the homeless population. The homeless population is already vulnerable. Additional factors like sexual orientation or race can make matters much worse due to pervasive problems related to discrimination (Gollust, Cunningham, Bokhour, et al., 2018). Measurable outcomes would again depend on the collection of survey data from multiple sources in different geographic regions, from healthcare organizations serving diverse homeless populations. Ethnic and racial disparities in healthcare service accessibility are even more prevalent for mental health services (Jones, Cochran, Leibowitz, et al., 2018, p. 2). Therefore, mental health services and program data needs to be included. The outcome measures also need to consider the particular needs of extremely vulnerable sub-populations such as children, and especially homeless children who are also minorities (Tan-McGrory, Bennett-AbuAyyash, Gee, et al., 2018, p. 1).
Another priority with regards to a comprehensive healthcare service strategy to meet the needs of the homeless population would be the development of a “partnership between health systems and housing services” (Katz, 2017, p. 2294). Such partnerships need to be executed at the municipal and state levels, but the foundations of those programs can be provided through a comprehensive federal policy that meets the overarching objectives. Measurable outcomes would be metric-driven, and purely quantitative including population health data linked to morbidity and mortality rates, collated according to specific subpopulations, specific mental and physical health conditions, and intervening variables. Strategic partnerships must also include ancillary services and programs related to occupational development and rehabilitation services. Outcome metrics would be linked to homelessness rate changes within a specific municipality, and could also include some qualitative outcome research such as case studies.
Another pressing need for addressing and ameliorating healthcare access disparities would be to reduce the cost burdens associated with unnecessary use of emergency services; healthcare utilization among homeless people is characterized by “high utilization of emergency or unplanned care resulting…from poor access to primary care services,” (Elwell-Sutton, Fok, Albanese, et al., 2016, p. 31). Measurable outcomes in this area would of course be linked to metrics related to emergency service access, but also to access of primary care services. In addition to primary care services, the proposed policy would also address the need for prevention services and programs including making health-seeking choices more accessible, such as opportunities for exercise or options for personal improvement such as free courses. Measurable outcomes would include the reduction in preventable illnesses and reduction in the rate of use of unnecessary emergency room visits. Notifications and Communications Strategy Awareness of the extent of the homelessness problem is itself not the issue; the issue is informing policymakers about the problems associated with inequitable healthcare access. The problem can be framed in financial terms, so as to motivate stakeholders uninterested in social justice. Informing policymakers through letters or presentations would therefore require the gathering of hard data, derived from large population samples from multiple geographic regions and also aggregate data. Also, the communications would include the financial data related to cost burdens associated with unnecessary use of emergency room services.
A public service marketing strategy would become an ideal medium to convey the importance of the initiative. The public service marketing strategy would involve various stakeholder groups with diverse target market needs, and it would also fulfill the need to garner public support. Public support for the initiative will ensure that the issue of homeless access to healthcare services is framed in ways that feature the long range impact on overall quality of life metrics. Developing the Initiative by Forming Strategic Partnerships Developing and implementing the initiative will require the formation of strategic partnerships at all levels, with multiple stakeholder groups. Healthcare organizations would be one of the most critical stakeholder groups involved in the process of developing the most effective policy reform measures. However, input from other stakeholder groups would be essential, too. The other stakeholder groups that would be involved include all health and human services organizations that already address the needs of the homeless. Most of these organizations operate on the municipal level, and a good number are not governmental organizations but non-profit organizations. Therefore, the construction of a nationwide strategy for reducing healthcare access disparities would depend on the

Plan Specifics This ambitious plan to aid the homeless by improving the accessibility to available healthcare services and resources includes four main components. The first involves fundraising—which requires positioning the issue in a way that attracts funding from as many different sources as possible. The second component is training and other human resource development concerns. The third is related to outreach and awareness, including the education of the homeless population and those at risk for homelessness at any given time. Finally, the plan entails providing additional healthcare services directly to the homeless on site, in shelters or wherever the community can allow.