Q&A: Improving care for homeless patients
Q: What advice do you have for case managers who are dealing with a high number of homeless patients?
A: Case managers can take several steps to improve care for homeless individuals.
Case managers should consider the association between a higher rate of traumatic brain injury (TBI) in individuals experiencing homelessness. According to a study published by The Lancet in December 2019, more than half of those who are homeless or considered “marginally housed” have experienced a traumatic brain injury at some point in their lives.
Because of the high rates of TBI among the homeless, case managers can consider lowering the threshold for neuroimaging referral when dealing with this population. If medical tests discover TBI-related damage, homeless individuals will have more opportunity to seek additional help and services.
Other strategies could include the following:
- Screen for social determinants of health. Approximately 24% of hospitals and close to 16% of providers only screen for one of the five full domains, according to Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP, author of the HCPro book The Social Determinants of Health: Case Management’s Next Frontier.
- Recognize the challenges that homeless patients face every day. Case managers need to be aware that homeless patients are “more susceptible to cognitive and behavioral deficits that easily impact their treatment adherence (and) health literacy,” says Fink-Samnick.
- Take a whole-patient approach in evaluating the patient’s needs. This includes accounting for stress levels, support networks, attitudes and beliefs, and a myriad of other factors.
For more information, see Case Management Monthly.