Homelessness, housing, and health geography: the impact of housing on the health of chronically Ill homeless adults.

University of Minnesota Ph.D. dissertation. August 2011. Major: Nursing. Advisor: Dr. Joan Liaschenko. 1 computer file (PDF); viii, 182 pages, appendices A-H.Interventions are needed to reduce the health disparities that exist in homeless populations. Housing, often viewed as an outcome to be achieved, has become increasingly recognized as an innovative health care intervention. Through the lens of health geography, this study sought to understand how housing is health care for formerly long-term homeless adults with chronic illnesses. The study (a) explores how the places of homelessness impact disease management, (b) identifies the processes by which the home becomes a therapeutic landscape, (c) explicates the place effects of housing on health, and (d) uncovers nursing‟s „place‟ on supportive housing teams. A sample of formerly homeless adults (n=16) was interviewed. Nursing (n=2) and non-nursing (n=9) service providers participated in focus groups. Findings reveal that homeless adults face extreme environmental, spatial, and social conditions, demanding creative strategies to manage illness. Closing the door on homelessness and making the home into a therapeutic landscape involves: negotiating home space with old and new social networks, finding a place that meets needs and desires, setting up a personal home, and enjoying home‟s sensual pleasures. The home affords a sense of normalcy and a desire to care for one‟s health. It also gives one the ability to care for health. Home essentials for health include: water, shelter, a private bathroom and shower, one‟s own bed for sleep and recovery, kitchen amenities, an electrical outlet, four walls, space and place for medications, an address and telephone, a place for pets, and a safe neighborhood. Nurses can be figurative stepping-stones out of homelessness and into health care. As care navigators, they assume some of the burden of disease management and triage, which is important for those newly housed and entering care for the first time. Providing care work on the street and in the home gives nurses an intimate knowledge of how „place‟ impacts a person‟s health narrative. These narratives are shared to advocate for client needs and encourage moral and political action. It is hoped that findings spur research on housing‟s effect on chronic illnesses; support homeless, housing, and health care policy; and guide nurses in place-based care work