For people living on the streets, health is a fragile commodity. J.T. was discharged from a Miami hospital four times before another facility admitted him for treatment. His issues were preventable, but without ultimately receiving interventional care, his legs would have required amputation. Also homeless in Miami, Alec was arrested 39 times—and taken to the emergency department 79 times—before being diagnosed with and treated for schizophrenia. A year and a half post-intervention, he’s had zero arrests or return trips to the ED.
Alec and J.T. are just two of Miami-Dade County’s more than 4,000 homeless people, a vulnerable, often invisible population that includes the elderly, working class, and children and families. They are also among the individuals for whom faculty and students at the University of Miami School of Nursing and Health Studies (SONHS) are delivering much-needed health services as part of a new nursing-led initiative recently awarded $25,000 by the UM Citizens Board.
“Exposure to homelessness leads to poor health,” explained SONHS senior lecturer Adrian Mesa, a family and psychiatric nurse practitioner who has worked with the homeless population for a decade, providing mental health services. “People struggling with homelessness have competing needs and co-existing health issues that interfere with them accessing treatment, food, shelter, or health care.”
As a result, he added, many members of this vulnerable community are caught in a costly and ineffective cycle of illness/crisis, hospital visit, treatment, and discharge back into unstable circumstances. To help halt this “revolving door” of often-preventable health concerns, Mesa, DNP, APRN, PMHNP-BC, FNP-BC, and Juan M. González, assistant professor of clinical and director of the Family Nurse Practitioner program at SONHS, collaborated on a plan to increase access to primary health care for patients living in a state of homelessness.
“Our program seeks to combat the health inequity that exists in the homeless population,” said González, DNP, APRN, AGACNP-BC, FNP-BC, CEN. “Achieving health equity in the homeless population of Miami Dade County is an essential public health outcome that strengthens the wellness and vibrancy of our entire community.”
Citizens Board Support
A couple of weeks before Thanksgiving, Mesa and González presented their initiative, “The Invisible Community: Connecting Hope and Health in the Miami-Dade Homeless Community,” to the University of Miami Citizens Board, which granted the proposal its top prize of $25,000 to help purchase medical equipment and supplies to screen homeless patients for chronic health conditions.
“Dr. Mesa, Dr. González, and the School of Nursing and Health Studies students will expand their incredible work with the support of this grant,” said Roberta Jacoby, president of the Citizens Board. “The ‘Invisible Community’ project serves a vulnerable population that goes unnoticed by many, and the funding of this project allows the first group of students to confront these health inequities in our community head on.”
Mesa and González both have previous experience leading clinical outreach efforts in vulnerable communities locally, as well as in the Caribbean and Latin America through the school’s Hemispheric and Global Initiatives. For this effort, they are working with the Miami Homeless Assistance Program, Camillus House, Choose Love Foundation, and Mother Teresa’s Missionaries of Charity to lead teams of SONHS nurse practitioner students in addressing primary health concerns affecting the county’s homeless population.
“Our nurse practitioner students, along with faculty like Dr. Mesa and I, are participating in this project to accomplish three main objectives,” said González. “1) Provide care to this vulnerable population that truly needs it. 2) Have students learn to care for these patients and develop empathy for them. 3) Establish a collaboration with these partnering agencies so this becomes a regular clinical rotation in our own backyards.”
Florida’s homeless population ranks third in the United States. Chronic homelessness and an inability to maintain proper hygiene increase exposure to infectious diseases. Crowding in places where homelessness exists leaves already ailing individuals open to a variety of communicable diseases, which spread through the homeless population and the community as a whole.
“Many homeless people suffer from secondary issues such as mental health, substance abuse, and sexually transmitted infections (STI),” explained González, a practicing Acute Care Nurse Practitioner and Certified Emergency Nurse. “Homeless women in particular are disproportionately affected and are often drawn into commercial sex trafficking to satisfy drug addiction and inadequate housing, leading to the additional spread of STIs.”
Experience and Empathy
Exposure to patients who are homeless will help students from the Family Nurse Practitioner program at SONHS develop the empathy required to properly care for individuals whose circumstances limit their access to basic health care and human needs.
“I am so proud of Drs. Mesa and González for their leadership in this important initiative," said Dean and Professor Cindy L. Munro, PhD, RN, ANP-BC, FAAN, FAANP, FAAAS. “They are addressing a critical gap in health care while giving our graduate students matchless hands-on experience delivering frontline care and advocacy in a resource-challenged environment.”
This local initiative will give participating nurse practitioner students, all of whom are already registered nurses licensed to practice in Florida, the chance to confront the health and social inequities homeless individuals experience while navigating inadequate health care options they face. Understanding such inequities and limitations will help these future nurse practitioners provide culturally sensitive care and innovate interventions for a subset population often struggling with co-existing conditions.
Using food distribution activities to reach patients, this student-driven, faculty-supported effort emphasizes strategic persistence to engender trust among the homeless community and ensure that multiple on-site visits of homeless clients continue each semester.
“The ‘Invisible Community’ assistance program will be integrated into the clinical curriculum, which will perpetuate a constant supply of health care providers for the Miami-Dade homeless population,” said González.
Addressing everything from high blood pressure and diabetes to more complex cases, these nurses can also serve as a safety net, sharing resources and assisting with health system navigation.
“We are grateful to the Citizens Board for so generously supporting this community-based project that seeks to bring hope and health to homeless and housing-insecure patients in our community,” said Mesa.
Photos by Dr. Adrian Mesa
