Nursing Care For Patients Experiencing Homelessness

Caring for patients experiencing homelessness starts with one fact: the barriers that keep them sick are mostly outside the exam room. A discharge plan that assumes a refrigerator, clean running water, or a safe place to sleep will fail before the patient reaches the parking lot. Your job is to meet the patient where they actually live, build enough trust to be heard, and advocate at both the bedside and the system level.

Homelessness in the U.S. is at a record high. On a single night in January 2024, more than 771,000 people were experiencing homelessness, the highest count since national data collection began in 2007 and an 18% jump over the prior year. Family homelessness rose 39% in that same span. Rising housing costs and a shortage of affordable units are the main drivers. Nurses see the downstream effects: patients who arrive in poor physical and mental condition, often after long stretches without care.

Barriers to Care

Several barriers limit access to care and raise the risk of chronic disease and premature death:

• Poor access to reliable transportation
• Discrimination
• Poverty and affordability
• No reliable access to clean water or electricity
• Substance misuse
• Poor mental health
• Negative past healthcare experiences
• Competing priorities like housing, safety, and food
• Low trust in providers and weak therapeutic relationships

Providers who have never lacked these basics often miss them. If you prescribe a medication that needs refrigeration, or order a wound dressing changed twice daily with clean water, ask where the patient will store it and how they will do it. A patient without a safe place for supplies, or without reason to trust you, will not follow a plan that ignores their reality.

How to Care for Patients Experiencing Homelessness

Use a holistic approach

Nurse-led models of care for people experiencing homelessness improve outcomes. Treat the mental, physical, and social problems together, not in isolation.

Establish trust first

Trust is the foundation of every other intervention. Listen, take the patient's account seriously, and learn how they actually manage their health day to day before you hand them a plan.

Assess immediate and long-term needs

Address the urgent problem in front of you, then look further out. Simple steps at the bedside can start case management, substance use treatment, housing referrals, or income assistance.

Provide trauma-informed care

A trauma-informed approach helps you connect patients to a medical home and advocate for the broader supports they need.

Advocate on both levels

At the individual level, advocacy can mean arranging clothing, transportation, a phone call, job leads, or weather survival kits. At the system level, it means working through legislation and community partnerships to close the housing gap and address the causes, not just the symptoms. Both matter.