Rethinking Homelessness: Extending Culturally Competent Care and Basic Humanity to the Homeless Population

At Pittsburgh Mercy Family Health Center, we strive to provide competent and compassionate healthcare to all individuals from different walks of life, including a portion of the homeless community. I serve as the coordinator for the Mobile Medical Unit (MMU) which consists of 2 patient rooms and most other aspects of a primary care office squished into an RV. The goal of the MMU is to offer primary care services to populations who commonly struggle with access to consistent, quality healthcare. The MMU partners with a homeless shelter that has the capacity to house around 250 individuals. Through my interactions with the patients at this site, it’s evident that there are multiple barriers this population faces including reliable, consistent communication and transportation. The MMU succeeds in overcoming a number of these obstacles, but I’ve realized that addressing access is only half the battle in providing comprehensive, competent care to individuals experiencing homelessness.

I was recently on the MMU chatting with a patient waiting for his appointment when it came up that he was currently homeless. I asked if he was staying at the Winter Weather Shelter, a temporary homeless shelter open every night between November-March. The patient explained that he stayed there for a couple of nights but stopped going because it was getting too crowded, loud, and rowdy. Instead, he’d rather stay in a public gazebo which he wrapped in a tarp to keep him insulated and warm during the colder nights. It then occurred to me that just because we have certain resources available, doesn’t mean they necessarily address all cases of homelessness. From this and many other interactions I’ve had, I realized how important it was for me to check my personal biases and assumptions about homelessness.

As a society, we tend to overgeneralize the homeless population. Our commonly accepted solutions are catchall, band-aid fixes: soup kitchens, homeless shelters, shoe box care packages, etc. Although important, this can cause us to forget the person behind the experience. Each case of homelessness is unique and personal. The quintessential depiction is street homelessness, but there is also unstable housing, transitional housing, and “doubling up.” This overgeneralization can cause us to forget that each individual experiencing homelessness, like all individuals, still has preferences, opinions, and autonomy. The Winter Weather Shelter might work for some but not for others, and it’s my responsibility as a Care Coordinator and future medical provider to work with each patient to devise a personalized solution that works best to address each individual’s situation.

There’s been a recent and necessary push for cultural competency in the workplace and in healthcare. The Association of American Medical Colleges defines cultural competency in a medical setting as “patient/family-centered care with an understanding of the social and cultural influences that affect the quality of medical services and treatment.” This idea is usually applied to differences in ethnic, language, and religious backgrounds. My experiences on the MMU have shown me that this practice must be extended to the homeless population, which starts with addressing our personal and collective preconceived notions of homelessness.

Sources

Association of American Medical Colleges. “Cultural Competence Education.” Cultural Competence Education, 2005, pp. 1–17.

This post was written by NPHC member Helina Gan.

Helina Serves at Pittsburgh Mercy Family Health Center as a Patient Navigator.