Is homelessness hopeless? Ending the crisis is urgent

Is homelessness hopeless? Ending the crisis is urgent
© Getty Images

As a nurse working in the health-care system in Chicago, I have witnessed many  homeless patients who weeks after discharging them, are nearby on the street holding cardboard signs with the words, “No home, no food, no job.”

Knowing what some of these patients were treated for, I also know they can add, “No way to pay for medications.”

What puts these people in this position is a failure in the system—not just locally, but nationwide — to address lack of access to health care as a factor of homelessness.

In Washington, D.C., where 191 people experiencing homelessness have died since 2014,  advocates have pledged to eliminate homelessness in the district by 2020.

In Denver, 233 people experiencing homelessness died in 2018, an increased number from the year before in an increasing homeless population.

In Louisville recently, Mayor Greg Fischer announced plans to address homeless with new funding for shelters, transportation and meals.

In these initiatives, no mention was made of health-care services. Without addressing the urgent need for health care and social services, a lasting impact on the homeless population is dubious.

As temperatures plummet this month and winter storms move across the country, providing shelter is necessary, of course. But without providing additional tools such as ongoing health care and education, training and opportunities for employment, the factors contributing to homelessness prevail.

The U.S. Department of Housing and Urban Development reported 552,800  homeless Americans in 2018, including 194,000 people without shelter. Yet  a subsequent HUD report, "Top Management Challenges” for 2019 and beyond makes no mention of homelessness.  

The federal count of homeless may even be lower than it is, as a recent Zillow study led by researchers from University of New Hampshire, Boston University and the University of Pennsylvania estimates that 660,996 people experienced homelessness in 2017.

Addressing this growing urgent national problem of homelessness must not be singular in approach. Yes, shelter is the first and most important step. But if the resources are not provided to help homeless people with social services, medical care, substance abuse, mental health, and training for employment, shelter is only a stopgap measure.

Health care and preventive health care may reduce homelessness and perhaps also the death rate of the homeless population. Blood tests, vaccinations and checkups can be part of a strategy that is more cost-effective than the direct and indirect costs of diabetes, heart disease, and other chronic conditions that also impact the person’s ability to earn a living.

In Oregon for example, The  Oregon Health Authority has a new Hepatitis A prevention strategy targeting the homeless population, where the disease is rampant.

The National Health Care For The Homeless Council offers a network of medical respite care providers. The council advocates for the homeless by educating health care professionals and the homeless on inadequate housing and the relationship to health.

The work of the council is based upon the notion that homelessness is caused by poor social and economic policies and pushes for changes in health care policy and promotes universal health care. Standards of care guide respite programs in delivering safe and effective health care to the homeless.

I have educated homeless patients on healthy eating and using their diet to improve their diabetes, heart disease, and high blood pressure. Yet given the choice between a $1 cheeseburger and a $6 salad, many take the more filling choice not knowing when will be the next meal.

I have discharged other homeless patients from the hospital to shelters only because they cannot be discharged to the street. It seems as though little is done to help them find a job or improve access to health care.  The individuals receive a roof over their heads for a few nights.

The hope is that hospitals and clinics will be able to provide more social services, mental health support, and continuity of care to patients who are homeless.

As health-care providers, we need to be aware of our roles in the crisis of homelessness and work to provide solutions that look at all contributing factors. It is my wish that the homeless people holding signs asking for help on the streets in any city do get all the help they need.   

Tricia Kierny is a family nurse practitioner and assistant professor at Rush University College of Nursing and a Public Voices fellow through The OpEd Project.