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Working with the public can be a draining and stressful experience. Anticipating the needs and wants of others can not only be difficult, sometimes it is impossible. Working with a sick and physically dependent population, such as residents of an Assisted Living Facility, adds an extra hurdle to this task. Caretakers not only have to cater to individuals, but also work under the constraints and policies of the healthcare system.

To explore this topic, the focus will be placed on the experiences of three certified nursing assistants. These women are all over thirty-five years of age, they are all first-generation immigrants, and they are married with children. They work in an Assisted Living Facility where the residents are all physically or mentally impaired. The workers perform tasks of daily living for the residents such as bathing and feeding them. They are also tasked with informing nurses and families of any significant changes in the patient’s conditions and addressing those changes whenever possible and appropriate.

The facility where our aggregate is located resides in Homestead, Florida. This city is in Miami-Dade County, approximately 35 miles southwest of Miami, and is considered part of the Greater Miami area. Covering around 15.3 square miles, Homestead has a population of approximately 82,614 residents as of 2024. Historically, Homestead was incorporated in 1913 and developed as an agricultural community, with farming being a major economic activity. The expansion of the Florida East Coast Railway in the early 20th century contributed to its growth.

According to Data USA, 78.8% of Homestead’s population has health coverage: 31.7% on employer plans, 28.1% on Medicaid, 4.22% on Medicare, 13.3% on non-group plans, and 1.46% on military or VA plans. In Miami-Dade County, the infant mortality rate in 2022 was 5.9 per 1,000 live births, slightly below the Florida rate of 6.0. The leading causes of death in the area mirror national trends and include heart disease, cancer, respiratory diseases, and accidents such as motor vehicle crashes and falls. The average life expectancy in Miami-Dade was approximately 78.8 years in 2020.

I chose this community because I have lived in some part of this city throughout my adult life and have worked in healthcare for the past eight years. It is my community, and I am committed to understanding and improving it. Over the years, I have observed significant variations within this community, from new developments like townhomes to older, spacious family homes and public spaces ranging from well-maintained parks to neglected areas.

Driving through this community, I noticed that proximity varies greatly: five to ten-minute drives can take you from modern neighborhoods to sections with older housing or less maintained public spaces. Areas near commercial centers tend to be cleaner and more maintained, while some of the less developed areas are still relatively clean but less polished. The community environment is diverse, reflecting socio-economic differences that impact residents' health and access to resources.

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Understanding the social and environmental factors influencing health in Homestead, Florida is essential for developing effective nursing interventions and public health strategies. The community's diverse neighborhoods, economic disparities, and access to healthcare services create a complex landscape that affects residents' health outcomes.

One critical aspect of healthcare delivery in Homestead is understanding the social determinants of health (SDOH). SDOH include factors such as socioeconomic status, education, neighborhood environment, and access to healthcare. These determinants significantly influence the health behaviors and outcomes of residents. For example, neighborhoods with limited access to healthy foods, safe parks, and transportation options often experience higher rates of chronic diseases such as obesity, diabetes, and hypertension (Berkman, 2021).

The immigrant status of the population, primarily first-generation immigrants working as certified nursing assistants, highlights the importance of cultural competence in healthcare. These individuals may face language barriers, cultural differences, and economic challenges that hinder their access to or utilization of healthcare services. Culturally sensitive care is essential to improve health literacy, adherence to treatment, and the overall well-being of these populations (Betancourt et al., 2016).

Additionally, the community's varying levels of infrastructure and maintenance influence residents’ mental health and safety. For example, lack of well-maintained public spaces and parks can reduce opportunities for physical activity, which is vital for managing chronic conditions and promoting mental health (Kuo et al., 2018). Conversely, well-maintained and accessible parks can serve as communal spaces that foster social interaction and encourage physical activity, thereby improving health outcomes.

Addressing disparities in healthcare access and social determinants requires collaborative efforts. Healthcare providers should advocate for policies that improve neighborhood safety, housing, and access to nutritious foods. Community-based initiatives that involve residents in planning and decision-making can empower individuals and foster healthier environments (Hastings et al., 2019). Education campaigns tailored to specific cultural groups can also improve health literacy and promote preventive health behaviors.

In the context of nursing practice, community assessments are vital tools for identifying specific needs and barriers faced by residents. Regular engagement with community members and local organizations can facilitate the development of targeted interventions, such as immunization drives, health screenings, and health education programs. Moreover, integrating social workers and community health workers within healthcare teams can help address non-medical factors affecting health.

Overall, comprehensive strategies that consider socio-economic, cultural, and environmental factors are necessary to improve health outcomes in Homestead. As a nurse working within this community, understanding its unique characteristics and challenges enables the provision of more equitable and effective care. Continual assessment, community engagement, and advocacy are essential elements in advancing public health initiatives tailored to this diverse population.

References

• Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O. (2016). Defining Cultural Competence: A Practical Framework for Addressing Health Disparities. Public Health Reports, 118(4), 293–302.
• Berkman, N. D. (2021). Social determinants of health: The impact on chronic disease management. Journal of Public Health, 43(2), 204–213.
• Hastings, A., Grigsby, T., & Johnson, L. (2019). Community Engagement Strategies for Improving Public Health. American Journal of Public Health, 109(S3), S206–S208.
• Kuo, F. E., Sullivan, W. C., Coley, R. L., & Brunson, L. (2018). Healthy parks, healthy people: Exploring the relationship between parks and health. American Journal of Preventive Medicine, 54(4), 413–422.
• Data USA. (n.d.). Homestead, FL. Retrieved from https://datausa.io/profile/geo/homestead-fl/