Ten years after its creation
through the Stewart B. McKinney Homeless Assistance Act, the federal Health
Care for the Homeless Program supports 123 grantees that provide primary care
and related services to nearly 450,000 homeless persons annually. Health Care
for the Homeless (HCH) is widely recognized as a very successful McKinney Act
program.
However, changes in the
health care marketplace, in public policy, and in the face of homelessness
itself are creating new demands for health services for homeless people even
as resources to meet that demand diminish. While HCH has never had sufficient
resources to address the health issues of all homeless people, distressing new
patterns of insufficiency are emerging.
In April 1997, the federal
Bureau of Primary Health Care
issued a Request for Proposals that allowed existing HCH grantees to apply for
a modest three percent increase in grant funding, to be used for expansion of
their activities. One hundred and eight HCH grantees responded by mid-June.
Collectively, their brief proposals comprise the best current national data
set on homelessness.
This report analyzes the HCH
proposals and provides a snapshot of homelessness in America in the early
summer of 1997, as seen by experienced, front-line providers of care. Among
its key findings:
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Homelessness is
increasing. On average, HCH projects report a 15.9 percent growth in
homelessness in their communities since last year.
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Overwhelmingly, HCH
projects report that changes in the welfare system are responsible for the
growth in numbers of homeless persons.
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Growing numbers of
uninsured persons seek HCH services. Overall, HCH programs report a 35
percent increase in the numbers of patients who are uninsured. This, too, is
attributed to changes in the welfare system.
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Specific health problems
are increasing among homeless people, particularly HIV/AIDS, tuberculosis,
substance abuse, chronic mental illnesses, diabetes mellitus and
hypertension.
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The HCH program has
experienced a 30 percent increase in the numbers of homeless individuals
seeking care. Among these, families and children make up the largest group
(55 percent).
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Financial support for HCH
projects is diminishing. The three percent grant increases requested in
these proposals will not support the increasing costs of current operations,
but must go to expansions of service. Thirty percent of HCH projects report
decreasing revenue from non-federal grant sources. Third-party (insurance)
revenue is also down, due to Medicaid managed care and increasing numbers of
uninsured patients.
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Consequently, 25 percent
of HCH projects have experienced direct reductions in staffing levels.
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HCH projects have
nevertheless managed to increase the numbers of patients seen, but are
unable to serve all eligible persons in need. Projects report growth in
daily clinic waiting lists, increased waiting time for appointments, and
turn-aways or referrals of potential patients to other providers.
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Overwhelmingly, HCH
projects will apply the three percent grant increases to basic primary care
services rather than to the ancillary services that have been one key to the
program's success.
For more information on
Increased Demand and Decreased Capacity or to get copy of the full report,
e-mail the National Health Care for the Homeless Council at
council@nhchc.org.
