Getting a flu shot every fall seems like a simple way to protect yourself, your family and friends, and colleagues from the flu. For people who are homeless or living in poverty, though, it's anything but simple, notes Diana Kane, MD, chair and medical director of Emergency Medicine at Chester County Hospital in West Chester, PA.
"Working in the ED [Emergency Department] we have this terror when flu season comes, as we know how many people in the U.S. die of influenza and its complications," Dr. Kane says. "We have a fairly large indigent or homeless population in this area and they don't have 20 dollars to go to Walgreens and get their flu shot. A flu shot is probably the lowest item on their list when they are concerned about food and shelter."
But when people in poverty do get the flu, their risk of transmitting it to others is high. Homeless shelters and day programs gather people in close quarters. Those who are homeless with the flu can't quarantine themselves at home, as is recommended for most people to prevent transmission. Without the opportunity to rest in their own space, they also take longer to recover and are at higher risk of complications. The homeless and very poor often lack access to healthcare, which means they are more likely to end up in the ED with flu symptoms - putting staff and patients at risk and increasing the likelihood of bed shortages.
"Lots of people come to the ED for the symptoms of the flu, but it is easier to send them home to recover - but not so much if they do not have a home to go to," says Dr. Kane.
This past summer, with the 2018 flu season looming, Dr. Kane consulted with Darren Girardeau, MSN, BM, RN, PHRN, CCRN, CEN, CFRN, director of Emergency Services, Radiology Nursing and Transport, to brainstorm ways for the hospital to bring flu vaccines directly to the poor and homeless at shelters throughout West Chester borough. Girardeau was aware of the Penn Medicine CAREs grant program, which provides funding for community-focused projects throughout the health system. He submitted an application that earned the hospital a $2,000 grant to fund a free, shelter-based vaccination program. The grant covered 160 free flu vaccines, with the hospital donating nurses' time and other supplies such as needles and alcohol pads.
"In nursing we want to care for people - that is always one of our motivating factors - but we also want to keep people well," Girardeau says. "Keeping these residents healthy and out of the ED has positive effects on the community. And our staff has less risk of contracting influenza." Even though ED staff members get vaccinated, a vaccine isn't foolproof, he notes.
From October 30 through November 7, 2018 the hospital's ED team offered six free flu vaccine clinics at three sites: Safe Harbor of Chester County, a homeless shelter; The Salvation Army of West Chester, which serves the homeless and people living in poverty; and St. Agnes Day Room in West Chester, a day program that connects poor residents with free meals, clothing, counseling, and other services. Fifty-one people were vaccinated. The team is planning to administer the remaining vaccines at the Domestic Violence Center of Chester County and other area shelters and day programs.
"It's rewarding to go out and do things for people when you are not behind your walls, your title, your uniform," says Dr. Kane. "We thought if we could vaccinate these people, we could decrease the rate of influenza, complications, and hospitalizations."
ED nurse Linda Detwiler, BSN, RN, administered vaccines at all three sites. "I volunteered because I could, plain and simple,"she says. "It is not a difficult thing to use your skills to help those in the community; it is actually a gift. I find it very gratifying to be part of a team that goes the extra mile to help keep our community healthy." Detwiler has participated in other service projects with the ED team, including Aidan's Heart Foundation screening events for young people, the fall cardiac screening for first responders, and the Home Cook Heroes Program at the Gift of Life Family House for transplant patients.
Related Information from Chester County Hospital: