Each night in the Springfield area, more than 800 individuals are homeless – 200 of those are unsheltered, living outside in places not meant for human habitation. In our recent point-in-time count of unsheltered homeless individuals, we found that 38.7% reported a chronic health condition such as heart disease, diabetes, COPD or cancer. Further, 25% reported a physical disability. For our unsheltered population, we know that without homes, people are exposed to the elements, disease, violence, unsanitary conditions, malnuturition, stress and addictive substances. Consequently, their rates of seriuos illness and injuries are 3 to 6 times higher than the average person. Resolving health problems is critical to resolving homelessness. (National Healthcare for the Homeless Coalition)
One of the ways Community Partnership of the Ozarks’ Continuum of Care is working to address this issue is through events like HOPE Connection, which give our homeless a one-day, one-stop-shop for medical needs including check-ups, vaccinations, screenings, and more. Individuals also gain access to vision needs, hygiene needs, drivers licenses, social security, job placement, veterans services, and more. Each year our number served goes up, along with the number of volunteers needed to make this event possible. If you would like to walk beside one of our guests for a day and see what it’s like to turn homelessness into HOPE, we encourage you to register to volunteer today. If you would like to learn more about Hope Connection or watch a video from last year’s event, click here.
Bed rest, healthy food, refrigeration for medications and the ability to stay out of the weather are critical to good health, but unavailable to those who are homeless.
In Missouri, over 2,300 individuals are living outside or in places not meant for human habitation, they are homeless and unsheltered. Roughly 12% of those individuals are chronically homeless. Chronically homeless individuals are homeless repeatedly – four or more times in the past three years – or for long periods of time, and they suffer from serious mental illnesses, substance abuse disorders, and physically disabling and/or chronic health conditions.
Each night they are exposed to the elements, disease, violence, unsanitary conditions, malnutrition, stress and addictive substances. Consequently, their rates of serious illnesses and injuries are three to six times the rates of other people. These conditions are frequently co-occurring, with a complex mix of severe physical, psychiatric, substance use and social problems.
“Caring for the homeless takes 2-3 times longer than that of a typical patient because you have to take a more holistic approach and find out how they are living and how that may affect your treatment options,” Dr. Mark Bower, Medical Director of The Kitchen Clinic, Springfield MO. For those with a chronic health condition requiring a consistent regime of prescription medication, living on the streets poses many challenges. Individuals who are unsheltered and living with Insulin dependent diabetes for example, find it difficult to maintain the medication’s proper temperature, which is vital to its effectiveness.
Housing is more than the structure that surrounds us. Housing is our sense of place, providing safety, solace, and comfort in times of struggle. The mental stress of homelessness can intensify mental health issues, continuing a negative cycle of hopelessness and despair.
You can help make a difference, you can give the homeless a voice.
“The homeless don’t talk so much about their needs, they wait until it becomes highly acute before they will generally seek out medical help. The day to day survival needs occupy so much of their time, they can’t concentrate on that need until it becomes highly acute.”
Achieving healthcare equity is a daunting challenge for any hospital or healthcare system, especially when it comes to the homeless and extreme impoverished. Constrained hospital budgets, insufficient staffing, technology gaps, and the absence of patient data are critical barriers.
For the unsheltered homeless, the challenge of managing healthcare is exacerbated by their lack of a fixed place to call home. Mobility rates among the homeless population can disconnect them from healthcare services, compounding health risks by delays in seeking care and inadequate access to health care. When an individual finally connects to care, it is usually at a later stage in the disease progression when treatment regiments may have to be modified to address the issue.
Healthcare providers report seeing individuals with multiple, complex, interrelated health conditions. They have chronic illnesses; they have acute illnesses – communicable diseases. The health situation of the poorest people in Missouri is very serious. (National Health Care for the Homeless Council)
The severity of health conditions can be exacerbated due to extreme poverty, non-adherence to therapy, cognitive impairment, and/or the adverse health effects of homelessness.
Typically uninsured individuals suffering from co-occurring disorders frequently use emergency room services to address complicated health needs exacerbated by living on the streets or in shelters. As a result, throughout the state of Missouri and across the nation, hospitals have become a safety net provider most affected when chronically homeless people lack access to primary care.
It is for this reason that communities must create specific and measurable actions to supplement the care provided by health care systems through safe, decent and affordable housing where possible.
By working together, at the state and local level, we can combine our resources to assist with this growing health care concern.
“I’m not the only one in Missouri with these issues to face, there has to be an easier way…”
As a state legislator for Missouri, we know and understand that you are faced with tough choices that will directly impact the health and well-being of ALL Missourians. You are our hope, you are our voice as we come together to tackle the most challenging healthcare issues of our time, especially for those that are homeless.
The most important way for you to help provide hope, healthcare and housing to Missouri citizens is to support efforts to address key objectives found in the United States Interagency Council on Homelessness’ Opening Doors -Federal Strategic Plan to Prevent and End Homelessness http://www.usich.gov/opening_doors
1. Improve access to and use of permanent supportive housing:
Permanent supportive housing using the Housing First model is a proven solution that leads to improvements in health and well-being. Supportive housing has also shown to be a cost-effective solution in communities across the country, especially where it has been targeted to people with the most extensive needs.
To learn more about the Housing First initiatives, visit: http://www.endhomelessness.org/pages/housing_first
2. Integrate primary and behavioral health care services with homeless assistance programs and housing to reduce people’s vulnerability to and the impacts of homelessness:
There is strong evidence for housing integrated with health care (Shelter Plus Care) as an effective and cost-saving intervention for homeless and unstably housed persons with serious health problems. These include people living with chronic disease and disabling conditions. The integration of housing with services is increasingly identified as a way to address complex health care needs that overlap vulnerabilities associated with race and gender, extreme poverty, HIV/AIDS, mental illness, chronic drug use, incarceration, and histories of exposure to trauma and violence, as well as homelessness
To learn more about Shelter Plus Care Programming in Missouri, visit: http://www.dmh.mo.gov/housing/shelterpluscare.htm
3. Advance health and housing stability for people experiencing homelessness who have frequent contact with hospitals and criminal justice:
People with serious mental illness who are homeless are often incarcerated when they cannot get the care and treatment they need. People with mental illness experiencing homelessness also frequently end up in the emergency room and hospitalized. These are expensive interventions that do not improve long-term prospects for people with mental illness who have no place to live. Effective targeted outreach, discharge planning, and specialized courts are proven to help keep people out of emergency rooms, hospitals, and jails and to connect people to housing, support, or for those who need it, supportive housing.
To learn more about Discharge Planning initiatives visit: http://www.nhchc.org/resources/clinical/tools-and-support/discharge-planning/
On behalf of Roberta, Belinda, Kevin and all other individuals who are unsheltered and homeless, we thank you for taking time to understand why Housing is Health Care.