Home. The word itself has so many connotations - a haven of comfort, a place to relax, refresh and be yourself. A place many people probably take for granted. I can't wait to get home; It's good to be home; I'm coming home.

Based on a study by the Texas Homeless Network, on any given day in the state, there are about 45,000 individuals who have no home to go to (Analysis of point-in-time estimates conducted in 18 communities in Texas during January 2007). With the obvious problems this presents for individuals seeking safety, food and shelter, access to healthcare is another layer of necessity that can easily be neglected.

Thankfully, for the approximately 15,000 homeless individuals in Houston, the Harris County Hospital District (HCHD) provides a destination for preventive care, maintenance of chronic conditions and even respite care for these patients, no matter where they've been resting their heads.

Dedicated Space
The Health Care for the Homeless program at HCHD began in 1987, and according to Julie Thomas, RN, FNP-BC, has continually increased the number of clinics and shelters served since its inception.

"The hospital district has a contract with each shelter it provides services to. There's a room designated for the clinic [in each shelter] and we have signs identifying the hours of operation," Thomas explained. Some some clinics may have a licensed vocational nurse or a patient care technician.

"When the client comes in, you have to wear many hats," said Robbie Taylor-Simon, RN, FNP-BC.

Clinic services include blood pressure screenings, diabetes screenings, immunizations and TB testing. Clients also come in to receive treatment for common ailments such as colds, respiratory illnesses, cuts and bruises.

"Of the disease processes we encounter, we can treat about 80 percent of what walks through our doors," Kymberli Zeno, RN, FNP-BC, noted. The clinics maintain a supply of basic medications for hypertension, diabetes, acid reflux and antidepressants. Diagnostic tests, labs and X-rays are not available on-site, and that's where the backing of HCHD comes into play.

"Any service we cannot provide on-site, we link the patients up with the HCHD Community Health Center full-service clinic," Thomas added. "Where we might not be able to provide [a service] inside the shelter, we can send the patient to the appropriate place to complete their care."

Rreferrals come complete with transportation vouchers so the clients can get to their appointments. For clients who aren't coming into the shelters, the homeless program brings the clinic to them with a mobile healthcare unit staffed by an LVN and a patient care technician, and a mobile dental clinic to provide access to oral healthcare.

"It's hard to get these clients to open up to you," Taylor-Simon said. "They are constantly sizing us up and trying to figure out what angle we're coming from."

But she quickly added the hard work pays off and related an experience with a client who had diabetes, was noncompliant with his medication and had out-of-control blood sugars. Taylor-Simon never gave up on him, but continued to care for this man until he learned to care for himself.

"Now, I have him on insulin, his sugars are in the 100s and he comes in [to the clinic] on his own," Taylor-Simon shared. "I really feel he's going to have a better quality of life because of the encounter he had at the shelter."

These encounters are orchestrated to introduce the concept of preventive healthcare and reinforce that idea with return clients. The staff  members try to get patients to consider smoking cessation, they talk to women about the importance of Pap smears and mammograms, and they talk to men about testicular cancer and self-exams.

"A lot of times, they don't know about health prevention, because they are so used to accessing the emergency room," Taylor-Simon said.

"By educating them, we're also helping the community and the city. We're decreasing the amount of 911 calls and decreasing the amount of nonemergent visits to the emergency room."