Guest Blog: Health Care and Homelessness, by Abe Oudshoorn

written by naehblog
December 16, 2010

Today’s guest blog post comes from Abe Oudshoorn, RN, PhD(c), Year 4 Coordinator, School of Nursing, The University of Western Ontario.

After spending three years on a Dissertation research study about homelessness and health care, I realized that I nearly missed the point.

I am a registered nurse by trade, and my clinical background is working with people who are experiencing homelessness in a community-based clinic. Based on my observations of the importance of healthy client-provider relationships, I set out to study these relationships, and particularly how power comes into play in health care relationships.

I had a lot to work with going into the study: I knew that people who are experiencing homelessness face the worst morbidity rates in Canada, I knew that homeless persons face multiple barriers to accessing health care, and I knew that negative attitudes of health professionals have consistently been identified as the primary barrier to care for homeless people.

So I did my study, and – sure enough – I heard and saw much conflict in client-provider relationships. But when I set about to write, my committee members asked about how policy impacts on my findings.

And this is what I almost missed: Indeed, health providers do use and abuse control with homeless clients, but much of the workplace context is beyond their control.

For example, in the clinic I was studying, there were very limited resources (socks, bus tickets, food and clothing) and providers were expected to police these resources. And the limited resources weren’t just a local policy issue; they reflected broader budgeting practices and what is valued in terms of demonstrating cost-effective health outcomes.

Therefore, rather than concluding that health professionals just need to be nicer in working with people who are experiencing homelessness, I believe we all need to reflect more on the health and social policies that frame our work. The policy context will always define what we can do and how we can do it, so we need to make sure that this policy context is optimally suited to doing the type of work that we know is best with our clients. Therefore, I believe that all health professionals need to be engaged in social and political action, creating or refining policies to shape the practice context we want to see.

For more information and reflections, Abe blogs regularly at, or you can follow Abe on twitter @abeoudshoorn.