"People who are street involved including those experiencing homelessness and substance use are at increased risk of morbidity and mortality"

No secret here, and the latest barrier to obtaining any healthcare at all from a county hospital here in Nashville comes to us courtesy of the Bridges to Care program, which is supposed to assist the poor and homeless at Metro General. I've talked about this before and it's no secret that a couple of the persons staffing this office are some of the rudest, most condescending pseudo-professionals I've ever had the displeasure of having to deal with. Aside from that, they treat everyone's application for assistance as suspect as far as I can tell, and have now initiated a policy in which direct service providers must have their letter of verification notarized before they will accept it. That's right, a letter, coming from a case manager on agency letterhead is apparently not good enough any longer; it must now be notarized before they will accept it. There is absolutely no reason whatsoever to implement a policy like this except to delay, inhibit and harass those who are attempting to acquire a Bridges To Care card. Not only does it slow the process down considerably, it is also costly and time consuming for the case manager and the client, both of whom are dealing with minimal amounts of discretionary cash. This policy is clearly designed to impede and protract the application process, and I suspect the ultimate goal is to so frustrate and hassle the person that they give up and stop trying. Pretty lousy treatment from a hospital that claims "We care for you. For life." No mention of how short that "life" might be as a result of the wait involved to obtain services.....

Drug Policy; Research on drug policy discussed by scientists at University of Victoria Anonymous. Drug Week. Atlanta: Aug 8, 2008. pg. 602 2008 AUG 8 - ( NewsRx.com) -- "People who are street involved including those experiencing homelessness and substance use are at increased risk of morbidity and mortality (see also Drug Policy). Such inequities are exacerbated when those facing the greatest inequities in health have the least access to health care," researchers in Victoria, Canada report. "These concerns have rarely been addressed in bioethics and there has been a lack of explicit attention to the dominant societal and organizational values that structure such injustices. The purpose of this paper is to describe the underlying value tensions that impact ethical nursing practice and affect equity in access to health care for those who are street involved. In this paper, findings from a larger qualitative ethnographic study of ethical practice in nursing in the context of homelessness and substance use are reported. The original research was undertaken in two 'inner city' health care centres and one emergency department (ED) to gain a better understanding of ethical nursing practice within health care interactions. Data were collected over a period of 10 months through face-to-face interviews and participant observation. In order to facilitate access to health care for those who are street-involved nurses had to navigate a series of value tensions. These value tensions included shifting from an ideology of fixing to reducing harm; stigma to moral worth; and personal responsibility to enhancing decision-making capacity. A context of harm reduction provided a basis for the development of relationships and shifted the moral orientation to reducing harm as a primary moral principle in which the worth of individuals and the development of their capacity for decision-making was fostered. Implementation of a harm reduction philosophy in acute care settings has the potential to enhance access to healthcare for people who are street involved. However, explicit attention to defining the harms and values associated with harm reduction is needed. While nurses adopted values consistent with harm reduction and recognized constraints on personal responsibility, there was little attention to action on the social determinants of health such as housing," wrote B. Pauly and colleagues, University of Victoria. The researchers concluded: "The individual and collective role of professional nurses in addressing the harms associated with drug use and homelessness requires additional examination." Pauly and colleagues published their study in International Journal of Drug Policy (Shifting moral values to enhance access to health care: Harm reduction as a context for ethical nursing practice. International Journal of Drug Policy, 2008;19(3):195-204). For additional information, contact B. Pauly, University of Victoria, School Nursing, Box 1700, Victoria, BC V8W 2Y2, Canada. Publisher contact information for the International Journal of Drug Policy is: Elsevier Science BV, PO Box 211, 1000 AE Amsterdam, Netherlands. Keywords: Canada, Victoria, Life Sciences, Bioethics, Drug Policy, University of Victoria.