Issues in community-based care among homeless minorities.

Homelessness is an increasing major public health problem in the United States. The homeless population consists of men, women, youth and families who live on the streets or in shelters. Minorities, especially African-Americans and Hispanics, are particularly at risk for homelessness due to their high rates of poverty. Homelessness predisposes persons to poor health, including a variety of acute and chronic physical and psychological diseases for which they often have difficulty obtaining healthcare. This article discusses common issues and challenges that homeless minorities and their health-care providers face in obtaining community-based healthcare, including issues in caring for homeless men and women, fragmentation of healthcare, perceived discrimination and provider bias, provider-patient trust issues, lack of access to care, and health literacy issues. Two programs designed to provide community-based experiential learning for nursing students to address these issues and the health-care needs of the homeless are described, i.e., the Men Achieving Self Health (MASH) and Women Inspired Self Health (WISH) Outreach Programs. Approaches used by faculty and students who are engaged in providing health-care services to the homeless via the MASH and WISH Programs are discussed.