Browsing by Author "Grengs, Leah"

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    Family matters: advance care planning for people experiencing homelessness
    (2011-04-13) Grengs, Leah
    The number of homeless individuals in Minnesota in 2009 was estimated at 9,452 youth and adults. Homeless people have been shown to die at 3 - 10 times the rate of the general population and at a younger age. Additional reasons that suggest the great need of advance care planning in homeless populations include the assumption that impoverished populations have poor health care and personal relationships. However, in my qualitative analysis of 70 advance directives of individuals experiencing homelessness the most striking result was the importance of family; evident in responses to every question in the advance directive. Combining data from the advance directives and surveys, I discovered that 60% of individuals saw their family regularly, felt that their family cared about them, trusted their family to make decisions concerning them and named a family member as their health proxy. After realizing the important role family played in the end of life preparations of individuals experiencing homelessness, I coded the advance directive responses regarding family, and found six major themes. The most common theme was "evidence of strong family values and relationships." Literature concerning family relationships of single homeless adults is scarce, since emancipation from family is a widely exploited assumption and often considered a main cause of homelessness. However, these data show that adults experiencing homelessness in Minnesota have strong family connections and values and want their family to speak for them in cases of serious illness or death.
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    Homelessness and End of Life Care: A Qualitative Analysis of the Living Wills of Underprivileged Individuals
    (2009-10-07) Grengs, Leah
    The major objective of this study is to test an advance directive (AD) intervention in the homeless population of Minneapolis and St. Paul. This project will address the end of life (EOL) concerns of homeless people and provide the basis to test the needs of others who are separated from their loved ones and/or experience episodic healthcare.   Estimates of the number of homeless people in the United States range up to several million. In the Twin Cities metro area over 4,000 youth and adults are in temporary housing programs and over 600 are unsheltered.   “Homeless” is defined as having no regular place to live (i.e. having to stay in a shelter, a hotel paid for with a voucher, a friend’s house, an abandoned building or outdoors).   Among disadvantaged populations, homeless individuals experience the greatest risk of death, barriers to healthcare and lack of resources and close relationships deemed necessary for proper EOL care.   Homeless individuals are admitted to the emergency room and hospitalized at almost four times the rate of the general population of the United States.   Although homeless individuals experience such high rates of mortality and hospitalization, their attitudes, values and desires regarding EOL care had yet to be studied. Their concerns have generally been ignored, since most EOL care has focused on the concerns of the white middle class. In general, homeless people have been found to be very willing to describe their preferences and concerns and eager to have a voice in what the future may bring in the event of serious illness or death. Homeless people have been found to have very unique concerns regarding healthcare and EOL care, since they frequently witness sudden and violent death on the streets.
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    Homelessness and End of Life Care: Analysis of the Living Wills of Homeless Individuals
    (2010-04-21) Grengs, Leah
    In the Twin Cities metro area over 4,000 youth and adults are in temporary housing programs and over 600 are unsheltered. Homeless individuals experience a greater risk of death and more barriers to healthcare than any other disadvantaged population. As a result of barriers to regular healthcare, homeless individuals are hospitalized and admitted to the emergency room at four times the rate of the general population. Few other studies have looked at the content of advance directives and no other study has looked at what the homeless write in their advance directives. A qualitative study of 73 advance directives of homeless individuals from Minneapolis showed evidence against many misconceptions people may have regarding the homeless: The majority of people named a family member as their healthcare agent and discussed family throughout their living will. Many of the homeless individuals discussed specific healthcare goals and were eager to improve or maintain their health. Many of the people wrote about specific accomplishments when asked what they were most proud of and wanted to be remembered for their personal traits, such as being good, kind or helpful.
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    Homelessness and End of Life Care: Methods to Study Health Disparities in Disadvantaged Populations
    (2009-04-08) Grengs, Leah
    There is a high prevalence of homelessness in St. Paul and Minneapolis as well as the United States. Estimates of the number of homelessness in the United States range up to several million. According to the Wilder Research Foundation, in the Twin Cities metro area over 4,000 youth and adults are in temporary housing programs and over 600 are unsheltered. “Homeless” for this study is defined as having no regular place to live (i.e. having to stay in a shelter, a hotel paid for with a voucher, a friend’s house, an abandoned building, outdoors or other places not intended for sleeping). Among disadvantaged populations, homeless individuals experience the greatest risk of death, barriers to healthcare and lack of resources and close relationships deemed necessary for appropriate end of life (EOL) care. Homeless individuals also utilize the healthcare system at a significantly higher rate than housed individuals. They are admitted to the emergency room and hospitalized at almost four times the rate of the general population of the United States. This is in a large part a consequence of their inability to access routine health care due to competing needs and lack of adequate health insurance. Although homeless individuals experience such high rates of mortality and hospitalization, their attitudes, values and desires regarding EOL care had yet to be studied. The major objective of this study was to test an advanced directive (AD) intervention in the homeless population of Minneapolis and St. Paul. Insights from this project will also be significant in the following ways: they will address the EOL concerns of homeless people and provide the basis to test the needs of others who are separated from their loved ones and/or experience fragmented, episodic healthcare. It is evident that homelessness research is particularly needed within the larger body of research on health disparities in disadvantaged populations. However, research on the health disparities of homelessness populations is scarce. This is in a large part due to the intimidating methodological challenges facing those who seek to study homeless populations. The itinerant nature of the homeless population is the greatest challenge that effects the retention rate of studies of homeless individuals. Retention rates in studies of homeless populations range from 30 to 86 percent. Previously used retention strategies included: outreach, phone tracking and gathering of anchoring points (information that will help locate an individual, such as an emergency contact). In this investigation, we employed both traditional and innovative methods to increase retention. We found that the effectiveness of these strategies varied considerably among sites. These findings identify the challenges and innovative methods utilized to study homeless populations and pave the way for further research of disadvantaged populations in the United States.