Unhoused Persons Care Access, Retention, and Engagement (UP-CARE)
Unhoused Persons -
Care Access, Retention, and Engagement
Dr. Asgary's lab
- There are more than 100 million people who experience homelessness worldwide. In the United States, each year, around 3.5 million Americans experience homelessness.
- Many of the homeless adults are in their fifties; 30% are women, and their healthcare issues are under-studied.
- The focus of the health system has, at best, been on addressing urgent issues of the homeless while neglecting preventive care, especially cancer screening.
- Perceived notion that the homeless have other important priorities or will later have the resources for preventive care/cancer screening, BUT
- Many will become homeless again.
- Significant numbers are chronically homeless.
- Most are single adults without family or social support who will likely continue to be under or unemployed without access to preventive care while struggling with fundamental social issues.
- Despite proven benefits of multiple strategies to improve preventive care among the general population for chronic disease management and to improve access to care, significant healthcare gaps exist among homeless persons.
- Translation of the evidence-based approaches and their system requirements is necessary to reduce the enormous gaps in chronic disease-related outcomes among homeless persons, addressing strategic objectives of HHS and NIH, and to improve access to preventive services.
Why does this matter?
Cardiovascular diseases and Cancer
They are the top two causes of death in homeless
persons over age 45, however:
- Rate of uncontrolled diabetes among homeless persons is twice more than the general population.
- Homeless hypertensive adults are two times more likely to have uncontrolled blood pressure compared to the general population.
- Homeless persons have four times the cancer rates and twice the cancer mortality of the general population.
- Cancer screening is greatly under-utilized by homeless persons, and the usual provider counseling and referral to specialists in the healthcare settings alone would not address their barriers and is difficult to effectively incorporate into their routine care.
- Population-level proven strategies such as patient navigator for cancer screening or chronic disease management have not yet been systematically tested among homeless persons.
Shelters
Shelters and shelter-clinics are among the very few places where they congregate, are reachable, and can access care and health promotion programs:
- Majority of homeless persons reside in shelters and 80% have cell phones.
- There are many shelters in virtually every large city across the US and the world that are accustomed to and already have case managers and some social service navigators to help homeless persons in a complex social system and connecting them with health services.
Digital Health
Homeless persons are mobile population. However, 80% have access to cell
phones which provides an unmatched opportunity for behavioral support, care coordination, and health promotion activities:
- mHealth including SMS text strategies have been tested to improve access to care among low-income populations but have not been tested in addressing cancer care or other preventive care among homeless persons.
Resources Materials
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Link to a resource page 1
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