On the Wednesday of Health Center Week, we note the important role of homeless health care in eliminating health disparities and ending homelessness in our country.
Over a million people who do not have homes are cared for by health centers each year. Many of our patients without homes have multiple complex, chronic diseases that drastically diminish their chances of ever functioning “normally” and escaping homelessness. Homelessness, as we have long known, is very often caused by poor health and its economic consequences, commonly causes poor health, and makes adherence to treatment far more difficult. Rates of all illnesses are 3-6 times those of other populations, and life expectancy for people who are homeless is 30 years shorter.
Health centers are helping to break this destructive cycle by providing accessible, quality, comprehensive care.
Accessibility for people without homes requires some extra effort for health centers. Dispossessed people are often reluctant to seek services in a system that has failed on every front to meet their needs, and competing daily imperatives to find food and shelter can keep them away from clinic doors. Many health centers, especially the 248 that are funded specifically as Health Care for the Homeless (HCH) projects, take care directly to the streets and shelters, actively seeking out the most vulnerable of our neighbors.
The majority of our clients who are homeless (62%) are uninsured, impeding their access throughout the health care system. In states that have chosen to expand Medicaid to people under 138% of the Federal Poverty Level, most of those experiencing homelessness will become Medicaid eligible on January 1. In “non-expansion” states, the very poorest people (those under 100% of poverty) will remain uninsured, and dependent on health centers, emergency rooms, and free and charitable clinics for their health care. On HCH Day 2013, there are different priorities for different states. Where Medicaid is being expanded, all agencies serving people without homes should be gearing up to help reach and enroll impoverished people; guarding against unaffordable co-pays is an important advocacy task. In states that have not yet chosen to expand Medicaid, the critical task is convincing state governments to do the right thing.
Quality care for people who are unstably housed is attainable. Good clinical practices like patient self-determination goal setting, motivational interviewing, and trauma-informed care are generating outcomes on a par with or better than the outcomes of other populations on measures like hypertension control.
Comprehensive care is possible in HCH because a multitude of actors collaborate with those inside the medical exam room to address the needs of the whole person, including mental health, substance abuse and social needs. Very importantly, 30 years of HCH practice have taught that housing is health care, and HCH projects are deeply involved in post-hospitalization Medical Respite Care and in Permanent Supportive Housing to assure that people have a chance to heal, recover, and live. These practices are highlighted in the Federal Strategic Plan to Prevent and End Homelessness.
The National Health Care for the Homeless Council is proud to partner with the National Association of Community Health Centers and other sponsors in inviting all parties to learn more about what we are accomplishing. Please explore the website for homeless-specific clinical guidance, materials on consumer involvement, health reform materials, policy alerts, membership information, and much more.
National Health Care for the Homeless Council