Refrain from being intrusive or judgmental Yes, I did encourage you to assess and gather pertinent information, but the key word here is pertinent. I have frequently been asked, “Why is this patient homeless?” I can think of patients who provide one reason, such as a sudden loss of income with an inability to find new employment, who then later disclose a history of abuse that led to initial estrangement from family and a longer history of homelessness than originally revealed. Start with what we need to know to address the issues at hand — the biggest of which is providing needed support to get started with treatment.
The “why” of the situation is less important than “what” and “how” we will address a cancer diagnosis and associated treatment.Fight the urge to ask questions regarding what you personally want to know … especially when or ifthe answer(s) will not impact care delivery. Rapport building is extremely important and develops over time; focus on details necessary to providing care. When there is disclosure, receive the information with respect and dignity.
Don’t take matters into your own hands Showing empathy for a person’s situation does not mean that we should begin discretely giving money or other needed items. We are each bound by a code of ethics that guides professional behaviors as well as our healthcare institution’s policy on gift-giving. If a patient needs a meal, for example, follow your institution’s policy on how to proceed. That may mean providing a meal voucher, which is available in general to all patients who meet certain criteria. This is not about intent; rather it’s about all patients having equal access to resources within established guidelines.
So how do oncology social workers actually address the problem of homelessness? In terms of available resources, it varies by state, county, or even community. Two patients experiencing homelessness may have very different needs. Oncology social workers assess patients by asking some of the following questions:
- How has this person survived? How are basic needs being met? Survival takes strength and resiliency, which deserves acknowledgement.
- What resources do they already utilize?
- What is important to them? What are they most concerned about at this time, now that there is a new diagnosis, or recurrence, of cancer?
- Is there truly no option for a place to live or have options been ruled out for various reasons?
- Who are this person’s supports and how are they utilized?
- Where do we truly need to start to address the problem? For example, access to food may be a bigger priority.
As a healthcare community, we must anticipate treating patients who are homeless. Some will remain homeless throughout the course of treatment, whereas others may intermittently have temporary shelter. Some may eventually have better community support engagement or even reach out to an estranged family member for help, and others will choose to limit contact. Realizing that there may not be an ideal solution, and that we may not be able to fix the problem are important considerations.
1. The Council of Economic Advisers. The state of homelessness in America. Executive Office of the President of the United States; September 2019. Accessed March 10, 2020. https://www.whitehouse.gov/wp-content/uploads/2019/09/The-State-of-Homelessness-in-America.pdf
2. Meehan M. Unsheltered and uncounted: rural America’s hidden homeless. NPR. July 4, 2019. Accessed March 10, 2020. https://www.npr.org/sections/health-shots/2019/07/04/736240349/in-rural-areas-homeless-people-are-harder-to-find-and-to-help