While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
Nurses can play a leading role in improving the health of distressed homeowners. That’s the view of Carolyn Cannuscio, Sc.D., an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2005-2007) and the lead author of a new study, funded by RWJF, about the effects of foreclosure on public health.
In the following interview, Cannuscio, an assistant professor at the Hospital of the University of Pennsylvania and the Veterans Administration Medical Center, and senior author Terri Lipman, PhD, CRNP, FAAN, a professor of nursing at the University of Pennsylvania, discuss the important role nurses can play in improving the health of homeowners in default. Cannuscio is one of a number of RWJF scholars and alumni who are exploring the link between health and foreclosure. Read a related story here.
Q: In the conclusion of your study, you write: “Nurses can serve as important advocates for health-relevant policy responses to the housing crisis.” Why do you focus on nurses as important advocates?
A: There are 3 million registered nurses in this country. Nursing education and practice emphasize both the medical and psychosocial aspects of health and health care, making nurses ideally suited to advocate on behalf of homeowners undergoing foreclosure. Nursing practice also emphasizes the health of families—and foreclosure represents a major life disruption that undermines the health and well-being of our nation’s adults and children.
In addition, nurses practice in a wide variety of settings where they are likely to encounter distressed homeowners and their children, including public-health clinics, home care agencies, hospitals and military facilities and, importantly, schools. In these diverse sites of care, nurses care for underserved, vulnerable populations and are therefore optimally positioned to identify and promptly intervene with homeowners who are at risk for stress-related mental and physical disorders.
Q: How do you envision nurses helping people in foreclosure?
A: Nurses are highly experienced in health screening, symptom management, and identification of community-based resources to support the health and well-being of individuals and families. Homeowners in foreclosure could benefit from the expertise of nurses in mental health screening, early identification of stress-related symptoms, and a holistic approach to treatment that includes practical strategies for both symptom management and addressing the underlying sources of stress. Nurses are well-positioned to make referrals to appropriate mental health providers, to low-cost or free sources of health care, and to social resources like food and housing benefits that may alleviate some of the material strain associated with foreclosure.
Q: What unique skills would nurses bring to helping people in foreclosure?
A: Nurses focus on health promotion and disease prevention. Homeowners in default or foreclosure represent an identifiable high-risk group that may benefit from the bio-psychosocial approach that is the essence of nursing education and practice.
Q: Are nurses currently involved in helping people with foreclosure, directly or indirectly, or would this be a new role for them?
A: Nurses have a well-established commitment to health promotion in America’s families. Families with young children are the fastest-growing population facing foreclosure. Ongoing programs across the country have employed school nurses to identify and intervene with children who are at risk of becoming homeless. Public health nurses have a long history of working with those who are homeless or at risk of losing their homes.
For example, in Ventura County, Calif., public health nurses have been on the front lines, indentifying and treating distressed homeowners. In their work, nurses have recognized and initiated treatment for a range of stress-related adverse physical and mental health effects associated with the current economic climate. These findings from the front-lines of health care mirror what we observed in our research.
Budget cuts across the country threaten important nurse-led interventions similar to the one in Ventura County. The California Nurses Association protested cuts to that program. Such cuts are shortsighted. Ultimately, our country will pay a high price for the adverse health and social consequences of the current housing crisis.
Q: Are there specific policies that could help nurses get into this role, or do you envision nurse leaders taking this on themselves?
A: Foreclosure prevention programs across the country would benefit from the valuable combination of medical and psychosocial skills offered by nurses. For example, in Philadelphia’s Residential Mortgage Foreclosure Diversion Program, distressed homeowners must meet with lenders prior to foreclosure in order to attempt to work out more tenable loan terms or a “graceful exit” for homeowners who cannot afford to remain in their homes. This program has been lauded as a success and has become a model for the nation. The lead judge, Hon. Annette Rizzo, JD, has a broad vision for the program, seeing the court as an opportunity to bring a range of needed legal, health, and social services to distressed homeowners. Here, nurses could serve as leaders in the health component of the intervention, conducting screenings and offering counseling and referrals to appropriate follow-up care.
In order to recover their mental, physical, social and financial wellbeing, families undergoing foreclosure need a range of supports. The causes of the current housing crisis were complex and often began with untenable loans, sometimes made in bad faith by unscrupulous lenders. Already-vulnerable families—especially African American and Hispanic families, families with young children, and single-parent households—have been hit the hardest by the housing crisis. These groups were disadvantaged in terms of health even before the current housing crisis. To repair the further damage caused by the housing crisis, our country must understand how the current housing crisis is also a brewing health crisis.
Nurses represent a large and powerful workforce that is committed to improving the nation’s health. We need to find creative ways to engage nurses and other health care professionals in order to prevent further damage from a housing crisis that has already cost millions of families their homes—and possibly also their health.
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