Health Care for Low-Income and Homeless People in the USA

As the demand for health care continues to steadily rise, underserved populations across the United States need more help than ever before. Waco is no exception. Stressed living situations contribute to an increased risk of illness and, in turn, out-of-pocket costs to treat these illnesses put a substantial strain on household budgets. Those who find themselves in deep poverty or homeless have literally no available income after they pay for their most basic needs.

Texas is one of five states that together account for more than half of the homeless population in the United States. According to the United States Census Bureau, 27.5% of the Waco, Texas population live below the poverty line, 20.4% which are uninsured, a number that is higher than the national average of 14%, 10.7% which are uninsured (Department of Congress, 2017). Of this population, point-in-time counts from the Central Texas Homeless Coalition estimate that 325 individuals are homeless and living on the streets, and Waco ISD estimates its homeless student population as approximately 6.14% of the total student population (Bednarz, 2018; Waco Independent School District, 2017).

Mission Waco recognizes that individuals and families experiencing deep poverty and homelessness are susceptible to the same health issues as those who are not. In an effort to address these issues, the Mission Waco Health Clinic, established in 2005, began offering a variety of services to low and/or no income patients who have no health insurance and/or no other option to health care services two days a week.

These services include acute care medical services (Tuesday and Thursday from 5-7 pm), dental services (extractions only twice a month), orthopedic services (once a month, by appointment only, and with referral from PCP), physical therapy and occupational therapy services (twice a month with referral from PCP), chiropractic services (1ST and 3rd Tuesday each month), vision screening (every Tuesday from 5-7pm), TB testing (every Tuesday), and psychiatric services (once a month with referral from FHC or Mission Waco). Services are provided on a first come, first served basis with the exception of those requiring an appointment.

During my time spent at the Mission Waco Health Clinic, I had the pleasure of meeting with Sara Lockett, RN, a volunteer nurse, a support staff member of Mission Waco, and coordinator of acute services at the Mission Health Waco Clinic. Sarah acknowledges, from a practice perspective, providing healthcare services that are compatible with work schedules offers a greater opportunity to address acute care needs of those individuals who have no other options. She states, “So many of our patients live paycheck to paycheck or have no source of income at all.

Both of which present a significant hardship in obtaining health care insurance” (S. Lockett, personal communication, October 9, 2018). Sarah, along with 18 volunteer doctors, and multiple dentists, nurses, chiropractors, orthopedic doctors, physical and occupational therapists, and countless individuals who volunteer their time to help with check-ins, create medical charts, and assisting in various other administrative tasks, play a major role in servicing this population seen in the clinic.

This is an important and often overlooked population. Sarah describes the population served at the clinic as men and women of all ages, races, and backgrounds. She acknowledges that patients encompass a wide range of ages from newborns, toddlers, preteens, teens and adult clients. They are single, married and divorced, with or without children, many of which work either part time, full time, or sporadically for temporary services.

Sarah states, “We don’t know what they have been through or may currently be going through, but we treat them with respect. In turn, through their gratitude, we know providing these services is truly something meaningful” (S. Lockett, personal communication, October 9, 2018). By being centrally located in the downtown area of Waco, the clinic is within walking distance for most of the patients served. The late hours of operation also allow for working individuals to obtain care after work.

Although I did not get to participate in the care of these individuals, I did however observe the care provided. During my time in the clinic, I learned by listening to patient’s stories as their healthcare needs were being addressed, that healthcare becomes a distant priority amid the daily search for food, clothing and shelter. Additionally, language, transportation barriers, and lack of affordable after-hour treatment, have prevented access in many instances. A total of 10 patients were seen during this two hour clinic with issues ranging from flu-like symptoms, to diabetic management, to hypertension, to gout, and to open wounds. I watched as treatment was provided and referrals made for continued care. It was rewarding to observe the context of this group of people who are so giving and devoted to helping people in need.

Vulnerable communities need health care solutions that make primary care affordable and accessible. Academic nurse managed health centers (NMHCs) are a well-established model that could be expanded upon, especially in underserved areas (Sutter-Barrett, Sutter-Dalrymple, & Dickman, 2015). NMHC’s can expand primary care services into the community and provide accessible quality health care services to underserved populations, while continuing to educate future professional nurse and other healthcare learners through education, research, practice, and service.

The overall goal of this collaborative effort is to improve access to health care and at-risk populations, breaking down the financial, social, cultural and transportation barriers that prevent people from seeking proper health care. In addition to promoting these clinics, we as nurses need to continue to focus and advocate for changes in local, state, and national policies to increase access, equity, and health protection for the underserved.

I understand that it is human nature to be more comfortable with the familiar, but it is not what we are called to in nursing. People are not their circumstances and as nurses we need to support a forward momentum out of unhealthy situations. Anchoring someone down under a label creates the risk of someone officially taking on that label and identity permanently. It’s time to change the language so that those affected by a circumstance or condition are upheld in the energy of transitioning into a better outcome. Everyone deserves the same care. Anything less is simply unethical.


  1. Bednarz, B. (2018, June 22). Homeless population declines in several Central Texas counties. Retrieved from
  2. Department of Commerce (2017). U.S. Census Bureau quick facts: Waco city, Texas. (2017). Retrieved from
  3. Sutter-Barrett, R., Sutter-Dalrymple, C. and Dickman, K. (2015). Bridge care nurse-managed clinics fill the gap in health care. The Journal for Nurse Practitioners, 11(2).
  4. Waco Independent School District (2017, June 22). Student demographics by year and campus: 2016-2017. (2017, June 22). Retrieved from

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