Hostname: page-component-848d4c4894-nr4z6 Total loading time: 0 Render date: 2024-05-17T23:57:28.526Z Has data issue: false hasContentIssue false
  • English
  • Français

Canadian Health Care Providers’ Perspectives on Working with Older Homeless Adults in Outreach Settings

Published online by Cambridge University Press:  07 December 2023

Veronica Sacco ,
Paul Stolee Open the ORCID record for Paul Stolee [Opens in a new window] ,
Ellen MacEachen  and
Veronique Boscart Open the ORCID record for Veronique Boscart [Opens in a new window]
Veronica Sacco
Affiliation:
School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
Paul Stolee*
Affiliation:
School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
Ellen MacEachen
Affiliation:
School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
Veronique Boscart
Affiliation:
School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
*
Corresponding author: La correspondance et les demandes de tirés-à-part doivent être adressées à : / Correspondence and requests for offprints should be sent to: Paul Stolee, School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 (stolee@uwaterloo.ca).
Get access Rights & Permissions [Opens in a new window]

Abstract

Service providers have a unique understanding of older homeless adults’ challenges and service needs. However, research on the experiences of health care providers (HCPs) who work with this population is limited. We aimed to gain a better understanding of the experiences (roles, challenges, and rewards) of HCPs who work with older homeless adults (age 50 and over) in outreach settings. We conducted individual semi-structured interviews with 10 HCPs who worked in these roles. Four themes emerged: (a) the client–provider relationship as an essential building block to HCPs’ work; (b) progression of care that acknowledges the “whole person”; (c) collaboration as integral to providers’ work; and (d) the importance of system navigation. Providers found their work personally and professionally fulfilling but were frustrated by system-level challenges. Findings can be used to identify strategies on how to further support providers in their roles and enhance service provision for older homeless individuals.

Résumé

Résumé

Les fournisseurs de services ont une connaissance particulière des problèmes et des besoins des personnes âgées sans-abri. Néanmoins, la recherche sur l’expérience des fournisseurs de soins de santé qui travaillent auprès de cette population est limitée. Nous avons cherché à mieux comprendre les expériences (rôles, défis et gratifications) vécues par les fournisseurs de soins de santé qui travaillent avec des personnes âgées sans-abri (50 ans et plus) dans des contextes d’intervention de proximité. Nous avons mené des entrevues individuelles semi-structurées avec 10 fournisseurs de soins de santé qui ont exercé ces rôles. Quatre thèmes ont émergé de l’étude: 1) la relation client-fournisseur en tant que pilier du travail des fournisseurs de soins de santé; 2) des soins progressifs qui reconnaissent la « personne intégrale »; 3) la collaboration en tant que partie intégrante du travail des fournisseurs de soins; 4) l’importance de savoir s’orienter dans le système. Les fournisseurs de soins de santé estiment que leur travail est personnellement et professionnellement gratifiant, mais sont irrités par les obstacles au niveau des systèmes. Les conclusions de cette étude peuvent servir à définir des stratégies pour mieux soutenir les fournisseurs de soins de santé dans leurs rôles et améliorer la prestation de services aux personnes âgées sans-abri.

Keywords

aginghomelessnessolder adultsqualitative methodshealth care providersoutreachvieillissementitinérancepersonnes âgéessans-abriméthodes qualitativesfournisseurs de soins de santéintervention de proximité
Type
Article
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 43 , Issue 1 , March 2024 , pp. 23 - 32
Check for updates
Copyright
© Canadian Association on Gerontology 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Barken, R., & Grenier, A. (2014, March 19). Rethinking the care needs of older homeless people. Retrieved May 18, 2021, from http://aginghomelessness.com/rethinking-the-care-needs-of-older-homeless-people/ Accessed on May 18, 2021.Google Scholar
Bharel, M. (2015). Doctoring for the homeless: Caring for the most vulnerable by building trust. American Medical Association Journal of Ethics, 17(5), 469–472.Google ScholarPubMed
Biederman, D. J., & Nichols, T. R. (2014). Homeless women’s experiences of service provider encounters. Journal of Community Health Nursing, 31(1), 34–48. https://doi.org/10.1080/07370016.2014.868733CrossRefGoogle ScholarPubMed
Birks, M., Chapman, Y., & Francis, K. (2008). Memoing in qualitative research probing data and processes. Journal of Research in Nursing, 13(1), 68–75. https://doi.org/10.1177/1744987107081254CrossRefGoogle Scholar
Bonin, E., Brehove, T., Carlson, C., Downing, M., Hoeft, J., Kalinowski, A., et al. (2010). Adapting your practice: General recommendations for the care of homeless patients. Health Care for the Homeless Clinicians’ Network. Retrieved March 20, 2021, from https://nhchc.org/wp-content/uploads/2019/08/GenRecsHomeless2010-1.pdf Accessed on March 20, 2021.Google Scholar
Bridges, D., Davidson, R. A., Soule Odegard, P., Maki, I. V., & Tomkowiak, J. (2011). Interprofessional collaboration: Three best practice models of interprofessional education. Medical Education Online, 16(1), 6035. https://doi.org/10.3402/meo.v16i0.6035Google ScholarPubMed
Brown, R. T., Hemati, K., Riley, E. D., Lee, C. T., Ponath, C., Tieu, L., et al. (2017). Geriatric conditions in a population-based sample of older homeless adults. Gerontologist, 57(4), 757–766.Google Scholar
Brown, R. T., Kiely, D. K., Bharel, M., & Mitchell, S. L. (2012). Geriatric syndromes in older homeless adults. Journal of General Internal Medicine, 27(1), 16–22. https://doi.org/10.1007/s11606-011-1848-9CrossRefGoogle ScholarPubMed
Brown, R. T., Thomas, M. L., Cutler, D. F., & Hinderlie, M. (2013). Meeting the housing and care needs of older homeless adults: A permanent supportive housing program targeting homeless elders. Seniors Housing & Care Journal, 21(1), 126–135.Google ScholarPubMed
Burns, V. F. (2016). Oscillating in and out of place: Experiences of older adults residing in homeless shelters in Montreal, Quebec. Journal of Aging Studies, 39, 11–20. https://doi.org/10.1016/j.jaging.2016.08.001CrossRefGoogle ScholarPubMed
Burns, V. F., & Sussman, T. (2019). Homeless for the first time in later life: Uncovering more than one pathway. The Gerontologist, 59(2), 251–259. https://doi.org/10.1093/geront/gnx212CrossRefGoogle ScholarPubMed
Canadian Mental Health Association. (2023). Harm reduction. Retrieved March 20, 2021, from https://ontario.cmha.ca/harm-reduction/ Accessed on March 20, 2021.Google Scholar
Canham, S. L., Custodio, K., Mauboules, C., Good, C., & Bosma, H. (2020). Health and psychosocial needs of older adults who are experiencing homelessness following hospital discharge. Gerontologist, 60(4), 715–724. https://doi.org/10.1093/geront/gnz078CrossRefGoogle ScholarPubMed
Canham, S. L., Davidson, S., Custodio, K., Mauboules, C., Good, C., Wister, A. V., et al. (2019). Health supports needed for homeless persons transitioning from hospitals. Health & Social Care in the Community, 27(3), 531–545. https://doi.org/10.1111/hsc.12599CrossRefGoogle ScholarPubMed
Culhane, D., Treglia, D., Byrne, T., Metraux, S., Kuhn, R., & Doran, K. (2019). The emerging crisis of aged homelessness: Could proposed housing solutions be funded from avoidance of excess hospital and nursing home costs? Philadelphia, PA.Google Scholar
Daily Bread Food Bank. (2001). Aging with Dignity?: How governments create insecurity for low-income seniors. Toronto.Google Scholar
Edmonston, B., & Fong, E. (Eds.) (2011). The changing Canadian population. Montreal, QB: McGill-Queen’s Press-MQUP.CrossRefGoogle Scholar
Gaboardi, M., Lenzi, M., Disperati, F., Santinello, M., Vieno, A., Tinland, A., et al. (2019). Goals and principles of providers working with people experiencing homelessness: A comparison between housing first and traditional staircase services in eight European countries. International Journal of Environmental Research and Public Health, 16(9), 1590. https://doi.org/10.3390/ijerph16091590CrossRefGoogle ScholarPubMed
Garibaldi, B., Conde-Martel, A., & O’Toole, T. P. (2005). Self-reported comorbidities, perceived needs, and sources for usual care for older and homeless adults. Journal of General Internal Medicine, 20(8), 726–730. https://doi.org/10.1111/j.1525-1497.2005.0142.xCrossRefGoogle ScholarPubMed
Gonyea, J. G., Mills-Dick, K., & Bachman, S. S. (2010). The complexities of elder homelessness, a shifting political landscape and emerging community responses. Journal of Gerontological Social Work, 53(7), 575–590. https://doi.org/10.1080/01634372.2010.510169CrossRefGoogle ScholarPubMed
Grenier, A. (2021). Late life homelessness: Experiences of disadvantages and unequal aging. Montreal, QC: McGill-Queen’s University Press.Google Scholar
Grenier, A., Barken, R., Sussman, T., Rothwell, D., Bourgeois-Guérin, V., & Lavoie, J. P. (2016a). A literature review of homelessness and aging: Suggestions for a policy and practice-relevant research agenda. Canadian Journal on Aging/La Revue Canadienne du vieillissement, 35(1), 28–41. https://doi.org/10.1017/S0714980815000616CrossRefGoogle Scholar
Grenier, A., Sussman, T., Barken, R., Bourgeois-Guérin, V., & Rothwell, D. (2016b). ‘Growing old’ in shelters and ‘on the street’: Experiences of older homeless people. Journal of Gerontological Social Work, 59(6), 458–477. https://doi.org/10.1080/01634372.2016.1235067CrossRefGoogle ScholarPubMed
Guillemin, M., & Gillam, L. (2004). Ethics, reflexivity, and “ethically important moments” in research. Qualitative Inquiry, 10(2), 261–280. https://doi.org/10.1177/1077800403262360CrossRefGoogle Scholar
Hahn, J. A., Kushel, M. B., Bangsberg, D. R., Riley, E., & Moss, A. R. (2006). BRIEF REPORT: The aging of the homeless population: Fourteen-year trends in San Francisco. Journal of General Internal Medicine, 21(7), 775–778. https://doi.org/10.1111/j.1525-1497.2006.00493.xCrossRefGoogle ScholarPubMed
Håkanson, C., & Öhlén, J. (2016). Illness narratives of people who are homeless. International Journal of Qualitative studies on Health and Well-being, 11(1), 32924. https://doi.org/10.3402/qhw.v11.32924CrossRefGoogle ScholarPubMed
Hopper, E. K., Bassuk, E. L., & Olivet, J. (2010). Shelter from the storm: Trauma-informed care in homelessness services settings. Open Health Services and Policy Journal, 3(1), 80–100.Google Scholar
Hunt, M. R. (2009). Strengths and challenges in the use of interpretive description: Reflections arising from a study of the moral experience of health professionals in humanitarian work. Qualitative Health Research, 19(9), 1284–1292. https://doi.org/10.1177/1049732309344612CrossRefGoogle ScholarPubMed
Kaplan, L. M., Sudore, R. L., Arellano Cuervo, I., Bainto, D., Olsen, P., & Kushel, M. (2020). Barriers and solutions to advance care planning among homeless-experienced older adults. Journal of Palliative Medicine, 23(10), 1300–1306.CrossRefGoogle ScholarPubMed
Ko, E., Kwak, J., & Nelson-Becker, H. (2015). What constitutes a good and bad death?: Perspectives of homeless older adults. Death Studies, 39(7), 422–432. https://doi.org/10.1080/07481187.2014.958629CrossRefGoogle ScholarPubMed
Lee, B. A., & Schreck, C. J. (2005). Danger on the streets: Marginality and victimization among homeless people. American Behavioral Scientist, 48(8), 1055–1081. https://doi.org/10.1177/0002764204274200CrossRefGoogle Scholar
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Thousand Oaks, CA: Sage.CrossRefGoogle Scholar
Liu, M., & Hwang, S. W. (2021). Health care for homeless people. Nature Reviews Disease Primers, 7(1), 1–2.CrossRefGoogle ScholarPubMed
McDonald, L., Dergal, J., & Cleghorn, L. (2004). Homeless older adults research project: Executive summary. Toronto, ON. https://www.homelesshub.ca/sites/default/files/attachments/Homeless_older_adults_research.pdf.Google Scholar
McDonald, L., Dergal, J., & Cleghorn, L. (2007). Living on the margins: Older homeless adults in Toronto. Journal of Gerontological Social Work, 49(1–2), 19–46. https://doi.org/10.1300/J083v49n01_02CrossRefGoogle ScholarPubMed
McGhie, L., Barken, R., & Grenier, A. (2013). Literature review on housing options for older homeless people. Hamilton, ON: Gilbrea Centre for Studies on Aging, McMaster University.Google Scholar
Morse, J. M. (2015). Data were saturated. Qualitative Health Research, 25(5), 587–588.CrossRefGoogle ScholarPubMed
Moskowitz, D., Glasco, J., Johnson, B., & Wang, G. (2006). Students in the community: An interprofessional student-run free clinic. Journal of Interprofessional Care, 20(3), 254–259. https://doi.org/10.1080/13561820600721091CrossRefGoogle ScholarPubMed
Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K. (2015). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health and Mental Health Services Research, 42(5), 533–544. https://doi.org/10.1007/s10488-013-0528-yCrossRefGoogle ScholarPubMed
Patrick, J. H., Pruchno, R. A., & Rose, M. S. (1998). Recruiting research participants: A comparison of the costs and effectiveness of five recruitment strategies. Gerontologist, 38(3), 295–302. https://doi.org/10.1093/geront/38.3.295CrossRefGoogle ScholarPubMed
Petersen, M., & Parsell, C. (2015). Homeless for the first time in later life: an Australian study. Housing Studies, 30(3), 368–391.CrossRefGoogle Scholar
Piat, M., Polvere, L., Kirst, M., Voronka, J., Zabkiewicz, D., Plante, M. C., et al. (2015). Pathways into homelessness: Understanding how both individual and structural factors contribute to and sustain homelessness in Canada. Urban Studies, 52(13), 2366–2382. https://doi.org/10.1177/0042098014548138CrossRefGoogle Scholar
Reynolds, K. A., Isaak, C. A., DeBoer, T., Medved, M., Distasio, J., Katz, L. Y., et al. (2016). Aging and homelessness in a Canadian context. Canadian Journal of Community Mental Health, 34, 1–13.CrossRefGoogle Scholar
Roulston, K. (2010). Reflective interviewing: A guide to theory & practice. Thousand Oaks, CA: Sage.CrossRefGoogle Scholar
Rowland, J., & Hamilton, J. (2016). Changing the face of homelessness. Paper presented at the 7 Cities Conference on Housing First and Homelessness, Calgary, Alberta.Google Scholar
Salem, B. E., Kwon, J., & Ames, M. (2018). On the frontlines: Perspectives of providers working with homeless women. Western Journal of Nursing Research, 40(5), 665–687. https://doi.org/10.1177/0193945916689081CrossRefGoogle ScholarPubMed
Sargeant, J., Loney, E., & Murphy, G. (2008). Effective interprofessional teams: “Contact is not enough” to build a team. Journal of Continuing Education in the Health Professions, 28(4), 228–234. https://doi.org/10.1002/chp.189CrossRefGoogle ScholarPubMed
Serge, L., & Gnaedinger, N. (2003). Housing options for the elderly or chronically ill shelter users. Ottawa, ON: Canadian Mortgage and Housing Corporation.Google Scholar
Sudore, R. L., Cuervo, I. A., Tieu, L., Guzman, D., Kaplan, L. M., & Kushel, M. (2018). Advance care planning for older homeless-experienced adults: Results from the health outcomes of people experiencing homelessness in older middle age study. Journal of the American Geriatrics Society, 66(6), 1068–1074.CrossRefGoogle ScholarPubMed
Sussman, T., Barken, R., & Grenier, A. (2020). Supporting older homeless persons’ positive relocations to long-term care: Service provider views. Gerontologist, 60(6), 1149–1158. https://doi.org/10.1093/geront/gnz171CrossRefGoogle ScholarPubMed
The King’s Fund. (2012). From vision to action: Making patient-centred care a reality. London: The King’s Fund. https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/Richmond-group-from-vision-to-action-april-2012-1.pdf.Google Scholar
Thomas, D. R. (2006). A general inductive approach for analyzing qualitative evaluation data. American Journal of Evaluation, 27(2), 237–246. https://doi.org/10.1177/1098214005283748CrossRefGoogle Scholar
Thomas, G. (2005). Harm reduction policies and programs involved for persons involved in the criminal justice system. Ottawa, ON: Canadian Centre on Substance Use. Retrieved June 4, 2021, from https://www.academia.edu/5670450/Harm_reduction_policies_and_programs_for_persons_involved_in_the_criminal_justice_system Accessed on 4 June4, 2021.Google Scholar
Thorne, S. (2008). Interpretive description. Walnut Creek, CA: Left Coast Press, Inc.Google Scholar
Thorne, S., Kirkham, S. R., & MacDonald-Emes, J. (1997). Interpretive description: A noncategorical qualitative alternative for developing nursing knowledge. Research in Nursing & Health, 20(2), 169–177. https://doi.org/10.1002/(SICI)1098-240X(199704)20:2<169::AID-NUR9>3.0.CO;2-I.3.0.CO;2-I>CrossRefGoogle ScholarPubMed
Tsai, J., Lapidos, A., Rosenheck, R. A., & Harpaz-Rotem, I. (2013). Longitudinal association of therapeutic alliance and clinical outcomes in supported housing for chronically homeless adults. Community Mental Health Journal, 49(4), 438–443. https://doi.org/10.1007/s10597-012-9518-xCrossRefGoogle ScholarPubMed
Tschanz, J. T., Corcoran, C., Skoog, I., Khachaturian, A. S., Herrick, J., Hayden, K. M., et al. (2004). Dementia: The leading predictor of death in a defined elderly population: The Cache County Study. Neurology, 62(7), 1156–1162. https://doi.org/10.1212/01.WNL.0000118210.12660.C2CrossRefGoogle Scholar
Watson, D. P. (2010). The mental health of the older homeless population: Provider-perceived issues related to service provision. Journal of Applied Social Science, 4(1), 27–43. https://doi.org/10.1177/193672441000400104CrossRefGoogle Scholar