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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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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