For Homeless, Housing is Healthcare

This month, the Journal of the American Medical Association(JAMA) reports that chronically homeless, ill individuals use emergency medical services less frequently when provided with housing and case management.  We have a board member who always says, “Housing IS healthcare!” And she’s right.

Having a safe place to recover means that a person experiencing homelessness does not have to battle weather conditions, lack of sleep, horrible nutrition, etc., in order to heal. When provided with housing and (the important piece) case management, motivated individuals do well.  And motivation can be acquired in the right environment.

The JAMA abstract notes, ”After adjustment, offering housing and case management to a population of homeless adults with chronic medical illnesses resulted in fewer hospital days and emergency department visits, compared with usual care.”

Dozens of people have told me that they don’t want to support homeless services.  I’ve heard that the homeless don’t want help or are hopeless cases.  I’ve heard that helping them is a waste of time.  This study is another step is dispelling the myth that homeless people want to be homeless.  Sure, you can find a few, but no one has ever begged me to get them back on the streets.

Ideological concerns aside, helping the homeless helps your bottom line. As this study shows, keeping homeless people off the streets results in fewer hospitalizations, shorter hospital stays, and fewer emergency department visits.  The money saved in the process is back in the taxpayer’s pocket.  And that’s something we can all support.

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Having a Crazy Day?

We are too!  Maybe you’ve noticed that the economy is down (although hopefully, hopefully recovering) and costs are up, but one thing that never changes is how grateful we are to our volunteers!

Volunteers help mitigate the stress of climbing bills and shrinking funding opportunities.  They have saved us from the most dreaded of tasks (fixing computers) and provided the most needed of services (counseling, meals, chaplaincy, and more).  So here’s wishing a happy National Volunteer Week to the crew at the Respite.  We couldn’t do what we do without you!

According to the the nursing and admin staff, because of volunteers . . .

“Clients get a chance to really socialize and participate in fun activities”

“I don’t spend hours and hours fixing computers!”

“Our clients receive extra support, friendship, and care above and beyond our basic services.”

“Our clients are surrounded by friends and neighbors who really care.”

“We are able to provide homecooked meals, flowers, juggling and entertainment, even holiday gifts!”

“I’m closing the last gaps in my paperwork, which is amazing!”

“We spend more one-on-one time with each client, which is inestimably valuable.  Without volunteers, I’d spend more time on paperwork and obstacles.  This way, we can really provide top-notch service and care.”

Thanks to everyone who donated time and talent this past year!

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Future Physicians Share Spaghetti, Stories

I’ve known a few people who made it through medical school living on Ramen and boxed macaroni and cheese, so when a group of 1st year medical students decided to prepare and share dinner this week, I crossed my fingers.

Little did I know, however, that these future physicians were going to whip up a meal that was both delicious and healthy.  Even our client from Serbia (whose English is improving) proclaimed the meal “very, very, very good!”

I’ll admit, I nabbed a couple bunches of  grapes.  So delicious! 

These students are just a fraction of our newest volunteer group from the University of Cincinnati’s College of Medicine.  They’re serving meals, interviewing clients, playing games, and bringing snacks as part of an ongoing project to benefit the Respite.

Plus, they sat down and ate with the clients!  I encourage every group to do this; sharing a meal relieves the potential awkwardness of  two groups of strangers meeting.  Plus, the clients usually tell the staff afterwards how much they enjoyed a homecook meal.  This way, they were able to tell the students directly.

There is always a need for physicians with experience treating homeless people.  Of course, a person is a person, but the experience of homelessness is a unique one.  While we benefit from the students’ efforts in the short run, we know it will be the homeless community that benefits long-term.  

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Juggling for a Cure

 Sometimes we all feel like we’re juggling – work, bills, family, health – it can seem like  a lot.  The Center for Respite Care’s staff and clients are no exception.  Like most nonprofits, we’re always trying to keep overhead as low as possible.  And our clients often stress over health problems, fractured relationships, rebuilding, dealing with lots of paperwork (getting ID’s, food stamps, etc.), and the day-to-day inconveniences of being poor.  Waiting for a late bus when you’re trying to get to the doctor is no joke!

All of this stress needs an outlet, and that’s where Juggling for a Cure comes in!  Friendly founder Ken Lewis is a U.S. Navy vet started Juggling for a Cure in 2008 and already has a busy schedule of performances.

I think when Ken first came in, I underestimated the value of this service.  Since entertainment isn’t essential, our staff tends to focus on the basics as much as possible.  Still, it’s great to see the clients get their minds off their troubles for a while, relax, and smile.

Plus, Ken doesn’t just perform, he also teaches – and learns – in front of his audience.  He has been coming to the Center for Respite Care for three months and with each visit he brings new skills to teach and props to share.  The audience gets a quick tutorial on how to learn juggling and Ken freely passes around his props for everyone to touch.  He even got us to participate.  Check out Ginger, one of our nursing assistants, learning to juggle below.  (She juggled two bean bags after only 2 minutes of teaching!)

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Cover the Uninsured Week 2009

Yesterday was the kickoff for Cover the Uninsured Week 2009.  Most of the patients at the Respite are uninsured.  In fact, if you receive our print newsletter, you would’ve already read a story about Walter, who became homeless as a result of his wife’s bills for breast cancer treatment.  (If you’d like to receive our print newsletter, email your address to respitesupport AT zoomtown DOT com).

The link between lack of health insurance and bankruptcy is clear: a 2001 Harvard study found medical bills to be a leading cause of personal bankruptcy.  And even those with health insurance may find  that their coverage isn’t sufficient to face major or chronic illness.  Student health plans, “mini med” plans, and limited liability coverage can offer lower premiums, but seldom afford the protection needed to weather catastrophic (or even serious) illness.

In November 2007, the Wall Street Journal reported on inflated medical bills received by Jim Dawson of Merced, CA.  After exceeding a $1.5 million lifetime maximum benefit on his health coverage, Dawson was slammed with $1.2 of grossly inflated medical charges.  Dawson’s charges were removed after the medical center received an inquiry from the Wall Street Journal, but few of my homeless clients are lucky enough to have a major media outlet report on their behalf!

It’s a problem from any angle: the same Wall Street Journal article noted that the hospital admitted its charges were necessarily inflated to account for the 2/3 of issued charges it would never collect.  And physicians’ skyrocketing malpractice insurance costs have forced some M.D.s to leave the medical world.  A New Hampshire emergency physician shares this perspective.

Many of the patients at the Respite have experienced the horrors of a lack of medical care.  When a medical concern arises, they typically wait until it becomes urgent to seek emergency care.  Even if they do seek medical attention early, homeless patients may be forced to wait until their illness or injury becomes an emergency so that they can qualify for free or subsidized services. 

Clearly, our healthcare system needs improvement.  I don’t want to discount the low-cost, free, and subsidized services provided so generously in the Greater Cincinnati region.  Low-cost medical and dental clinics and relief from hospital bills are services that homeless men and women rely on.  Still, there is much work to be done in improving healthcare for the homeless.  Cover the Uninsured Week is just one more great reason to mention it.

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Warning: Disturbing Images

Today, I want you to meet David.  More importantly, I want you to meet David’s feet.  I talked about David in last week’s post, and David has even been mentioned in the Enquirer.

But I don’t know if you really understand David’s feet.  Frostbite sounds bad, but not horrifying.  I think David’s feet are horrifying.  Horrifying because they display the needless injuries inflicted on everyday people who can’t afford medical care.  Horrifying because they are the result of honest work, not substance abuse or living on the streets.  In fact, David lost his job because of the injury, not vice versa.

I’ve posted pictures before to show you what we do at the Respite.  You’ve seen clients after healing and recuperation, after housing and health.  Here are pictures of what an earlier stage in that process looks like:

Can you say "no" to healthcare for the homeless. . .

. . . after seeing how bad it really can be?

People say, "I don't want my tax dollars to be a free ride for someone who's just lazy."

See any lazy people here?

It’s easy to write off the issue of homelessness through stereotypes.  It’s not as easy to deny urgently needed medical care because of assumptions about past actions or potential for the future.  The health care needs of homeless individuals in our community are serious and growing.  People like David need help now or they risk drastic consequences.

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How We Identify with Homelessness

Reading other blogs about homelessness is a curious thing.  There are blogs by those who are or have been homeless, those who work or volunteer with a homeless clientele, and blogs about other topics that mention homelessness once in a while (typically when the author has an encounter with a homeless person).

The most frequently commented upon blog articles seem to be those about an individual’s first night of homelessness.  I admit, I frequently leave comments on these articles myself.

Why is it that we’re so sympathetic to the person who experiences their first day of homelessness, but callous toward the person who has been homeless for months or years?  It’s a matter of perspective.  The person spending a stray night in a homeless shelter could well be us, we think.  

What if we lost our jobs and had a concurrent major illness?  What if a loved one (or ones) passed away suddenly?  What if . . . whatever combination of tragedies it might take.  I think we’ve all had thoughts that it could be us.  For some it might take more tragedies than others, but the possibility is there.

In considering the chronically homeless person, we’re less sympathetic.  Why?  Because we believe we cannot sink to that level.  We would pull ourselves out or find help somehow.

We may be able to make the leap to understanding who someone (even ourselves) can become homeless, but we believe that if you’re homeless for more than a few weeks, well, you must just be lazy.  Or ignorant.  Or an addict.  Why don’t they just get jobs after all?  Or just apply for the loads of benefits we finance through our taxes?  Or get social security?

We fail to consider the psychological effects of life on the streets.  It takes many of our clients several days to warm up to staff at the Respite and our mission is to help them.  Imagine how difficult they find it to reconnect with family and friends.

And all those “free benefits”?  True, they’re out there.  But how long can you afford to wait?  It can take weeks to qualify for food stamps, months to gain tenant-based rental assistance, and years to be awarded social security disability.

As for employment, would you hire someone who admitted to being homeless?  How about someone who claimed to have stable housing, but was mysteriously never home when you called?  Would you hire someone with dirty fingernails or ragged clothing?  Maybe you would.  Then again, maybe you’d prefer to hire the clean-cut teenager who made the honor roll last quarter.

Are we really as impervious as we believe?  Or is the hard truth that homelessness, once it happens, can be nearly impossible to escape?  How many of these truths do we ignore because they are simply too frightening to accept?

The ultimate truth is surely more complex, but everytime I read comment-loaded articles about an individual’s first terrifying night as a homeless person, I wonder.

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Homeless Blog Round-up

I read as many blogs about homelessness as I can.  It helps me keep abreast of what others are thinking, and how homeless issues are perceived in other communities.  Some viewpoints are almost expected, others are just discouraging, and the best ones impact my perception of homelessness and the Respite’s role in serving our community.  Three of my favorites from the past couple days are below.

1) Burned to Death for Being Homeless  - The title, unfortunately, gives you a good idea what this article is about.  I’ve read at too many similar articles in recent weeks and months.  Without being sensational, I wanted to share this one because despite the horrific nature of these incidents, they continue.  The idea that a life might be extinguished for entertainment underlies the most base societal attitudes about homeless people: that they are not human, not even less than human. 

2) Where’s the Messenger? - This article is a good read for nonprofits serving the homeless.  It closely examines our duty to educate the public, not just fundraise.  While “raising public awareness” does, I’m sure, factor into most nonprofit’s goals, we don’t always do as much as we can.  Let’s face it: between serving our clients, connecting with supporters, friends, and volunteers, maintaining our grant support, valuing staff, and dealing with daily crises (broken computers, squirrels on the porch, inspections, power failures, leaking washing machines), well, maybe we don’t keep this function in mind as much as we should. 

3) Why do you look away? - Some of the most powerful blog entries are those written by homeless people themselves.  This one talks about the flip side of homeless people on the streets.  I see tons of articles written by people who encountered a homeless person during the day.  Some express remorse for not being able to help, others show guilt or pity, and a predictable portion express disgust, even rage.  This article is a sobering look at the flip side of the situation.

Is there an article about homelessness that caught your attention lately?  Share a link in comments.

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Ask a Homeless Person: What Does Poverty Mean?

Happy Blog Action Day!  Despite writing about homeless people and the medical needs of this population all the time, I sometimes forget to consult the panel of experts (often referred to as our clients) that hang out on the Respite porch every afternoon.  Today, everyone was playing cards.  They let me interrupt to ask this question about poverty: What does it mean to be poor? 

Being poor means .  .  .

. . .fear of the future.

. . .a certain state of mind.

. . .appreciating things more.

. . .being scared.

. . .being treated like a second class citizen.

. . .there’s nowhere to go but up.

. . .you work hard to change your life to make it better.

. . .being frightened.

. . .wondering where meals will come from the last week of the month.

. . .lack of knowledge, not having much self-esteem.

. . .lack of independence.

. . .being without and being depressed.  Every day of being homeless is depressing.

. . .insufficient funds.

. . .being lost in the world.

 

I bolded the answers that my “experts” liked best.  Those two responses elicited an immediate approval from everyone in the vicinity. 

Finally, do you notice now many answers revolve around fear?  For those experiencing homelessness, extreme poverty is more about fear than money.

Another tenet of Blog Action is discussing solutions to the issue.  This is a gargantuan task.  Money alone isn’t going to work – everyone at Respite told me that today.  Compassion would be a start, maybe a huge start.  There is so much animosity towards those who are poor in the United States.  We’re willing to travel extreme distances to help out abroad; what about those in our community who are in need?

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Sleeping in a Homeless Shelter

I was tag surfing today, checking out other blog articles on homelessness and found a great description of one woman’s first day at a homeless shelter.  It contains many of the details I’ve heard from Respite clients (about their stay at “traditional” emergency shelters, not a respite facility), along with the fear, worry, and unease inherent to the situation. 

As you can tell from the woman’s description, a typical shelter is no place for someone to try to recover after being hospitalized, having surgery, or being released from an emergency room.  There are showers and a place to sleep, but in the wee hours of the morning, each person must return to the streets.  For an injured person, this would surely contribute to repeat hospitalizations and ER visits.

Running a homeless shelter is definitely a balancing game.  If you provide more services, you serve fewer people.  If you try to serve everyone, you can’t provide as much help for each individual.  At the Center for Respite Care, we provide medical recovery and 24-hour shelter.  We have high success rates for our population, but we are limited to serving fourteen people at a time.  Luckily, there are other agencies in Cincinnati that create something of a safety net, but we do sometimes turn people away because we don’t have the resources to serve them.  On the upside, we’re the only agency in Cincinnati that providing this service and can hopefully expand our size in the future. 

If you’ve never heard of the Center for Respite Care (or other similar respite care provider for the homeless), I’d urge you to visit our website: www.homelessrespite.org.

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