These Doctors Make House Calls...to the Homeless
By Maryellen Hess Cameron, M.P.A.
Cancer InCytes Magazine - Volume 4, Issue 2, Winter 2015
Published December 7th, 2015
Managing Editor: Juliana Zhu, Esq.
Cover Art: Ping Cao
Most of us can visit a doctor within a short distance, and with the Affordable Care Act millions more can now afford it. But there continues to be a deep chasm between health care and the homeless. Long term homeless people live with chronic illness as just another hardship in a life of isolation and deprivation. Stigma and uninformed judgement of them follow them everywhere. A few progressive physicians have taken their services to the streets, making house calls on homeless people wherever they are. Carrying backpacks of supplies they can often avert health crises. They connect with people and encourage them to follow up for ongoing treatment. They may save thousands of dollars for each person who does not end up in the emergency room or in a hospital for a condition that could have been treated. Policy makers as well as social service organizations could learn a thing or two. These acts of compassion demonstrate what works with improving health conditions among the homeless. We should also remember these doctors are doing more than treating illness and saving lives. They are bringing a little bit of dignity back to people who lost it long ago.
“An ounce of prevention is worth a pound of cure.” Benjamin Franklin spoke no truer words. It is the reason the Affordable Care Act (ACA) requires insurance companies to provide wellness exams at no cost to the patient. What is the pain and suffering of a stroke compared to treatment for high blood pressure? Standard tests can reveal all kinds of health threats flying under the radar. Health care providers could see vastly improved outcomes with early detection. And everybody saves money.
The trick is getting the potential patient to seek out care. The whole point of both the ACA and government sponsored insurance is to mitigate the barrier of cost. Literally millions of people can now afford a trip to the doctor.
Yet no insurance program can break down the barriers to care for people living “rough.” If we want a healthier society we have to find ways to serve homeless people. They are already at much higher risk of earlier onset and more severe illnesses. Given the transient nature of homelessness it is hard to say how many people need to visit a doctor for preventive or early stage care. What we do know is that emergency rooms fill with homeless people suffering a health crisis.
Long-term homeless people suffer higher rates of disease and shortened life spans. Street homelessness creates the obvious exposure to poor weather, extreme heat, cold and rain. Diets are sporadic and dependent on what is available, not on what is nutritious. If they have received treatment it is a daily challenge to follow a regimen. Medications are stolen. It is difficult to take them as prescribed, such as with food or at certain times of day. Cleanliness is a luxury. Consider this appalling statistic: long-term homeless people suffer a mortality rate four to nine times higher than those who have homes. (1)
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American health care traditionally relies on patients going to the location of health care services. There are doctors and nurses who get that this system will not reach the most vulnerable people – those who are homeless. Instead they equip themselves the best they can and seek out folks on the street and in emergency shelters. Dr. Jim Withers has given his time and compassion to people on Pittsburgh, PA streets for over 23 years. (2)
Withers told CNN he, "was actually really shocked how ill people were on the street. It was like going to a third-world country." (3) Perhaps it was instinctive but Dr. Withers chose a different uniform from a white lab coat, instead wearing grubby jeans and rubbing dirt in his hair. Homeless people are more accustomed to sneers than smiles.
Dr. James O’Connell is to Boston, MA what Dr. Withers is to Pittsburgh. (4) Dr. O’Connell is president of Boston Health Care for the Homeless, an organization that now works in 65 sites throughout the area. In an interview with host Terri Gross, Dr. O’Connell described his process as, “basically visiting them in their homes, which are often under bridges, down back alleyways and park benches.” (5)
Over the years, O'Connell has seen the ravages of untreated frostbite, AIDS and diabetes, as well as the effects of profound isolation and extreme loneliness. Dr. O’Connell admits he had to learn to suspend judgement about the people he set out to treat. "These are people who are nameless and faceless when they are sitting out in the street," he says. "But when you get to know them, they are stories of great courage, of struggles against unbelievable adversity. ... I think I probably would've been a broken person had I lived through what they lived through." (6) (Gross, 2015)
Maryellen Hess Cameron, M.P.A.
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"Doctors on the Streets" is a completely volunteer-based program in Cleveland, Ohio (7) where doctors go out on Friday nights to see people sleeping in public areas and in shelters. Kenneth Williams, a shelter patient, said it was like germ warfare going on in his chest and without the help he said he “would have been in big trouble.” (8)
Many doctors, nurses and other health care providers throughout the country volunteer in community clinics and on mobile health vans. They are all living up to the credo that medical care is a helping profession. But the doctors on the streets know there’s more at stake in reaching those who are afraid or have had bad experiences in the past.
So why is it an exceptional experience for doctors to go to the homeless? And why does it have to be as a volunteer? The care they provide not only prevents suffering, but it saves enormous amounts of money. How much? Well, Californian Angelo Solis racked up nearly $1 million in medical charges – paid for by taxpayers. (9) Time after time police would take a passed out Solis to the ER where he could detox and get help for his diabetes and heart disease. But nothing changed.
One million dollars would pay for a lot of home visits by doctors to alleys, parks and emergency shelters. It seems like a no brainer. The practice of short term thinking leads policy makers to question who will pay for it.
In reality there are multiple agencies that could invest in this kind of outreach. All would save money and all would reduce their workloads.
If any organizations should see the long-term benefits it would be hospitals, insurers and Medicaid/Medicare. Even paying a premium to health care providers who work on the streets would save along the whole continuum of care – vaccinations to improved heart health.
Law enforcement systems can dedicate their finite resources to improving community relations and crime fighting. As a matter of public safety and public service police are often the ones who find the homeless person in crisis and transport him/her to the ER.
Mental health substance abuse organizations might be the biggest winners of all if they contributed to the cost of street-based medical care. People with psychoses may easily be afraid of health care workers they don’t know, but Drs. Withers and McConnell both have succeeded in building trust with those they help.
There’s a huge added bonus for mental health care providers. While health care providers are addressing infections and high blood pressure they can discreetly screen for human trafficking, drug use and domestic violence.
Then there’s the cost of unintended pregnancies and lack of pre-natal care. Street care offers a chance to discuss and disperse contraception. Better pre-natal care reduces the incidence of infant mortality and premature births; it could reduce the incidence of babies born addicted to drugs or severely disabled.
If all of these service providers decided to collaborate on managing and paying for street based care we can at least reduce the suffering of our homeless citizens. And all of that money that we save on medical care could pay for housing. Then one day we would not need street-based health care. The truth is: housing is health care.
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About The Author
Maryellen Hess Cameron, MPA, led ICAN Housing in Canton, Ohio for over 15 years, an organization dedicated to ending homelessness for persons with mental illness. Following a career as a freelance journalist, Ms. Cameron earned her Master’s in Public Administration to pursue social change. She has advocated at the local, state and national level to increase resources and enact policies that can solve issues such as homelessness, domestic violence and access to better mental health treatment. Her publication, “Safe Home: A Guide to Affordable Housing for Domestic Violence Service Providers and Survivors” helps service providers understand and access federal housing assistance for their clients. She is also an Editorial Adviser for Cancer InCytes Magazine. You can learn more about her at www.maryellenhess.com.
Center for Disease Control. (2015, October 21). National Homeless Person's Memorial Day. Retrieved from Center for Disease Control web site: http://www.cdc.gov/features/homelessness/index.html
O'Reilly, C. (2015, 10 16). CNN. Retrieved 10 16, 2015, from CNN.com: http://www.cnn.com/2015/05/07/us/cnn-heroes-homeless-doctor-jim-withers/index.html
Gross, T. (2015, September 29). NPR Fresh Air. Retrieved 10 21, 2015, from Health News: http://www.npr.org/sections/health-shots/2015/09/29/444214320/house-calls-to-the-homeless-a-doctor-treats-bostons-most-isolated-patients
Gross, T., 2015
Gross, T., 2015
Ramirez, C. (2014, March 1). Doctors on the streets. Retrieved October 21, 2015, from NewsNet5: http://www.newsnet5.com/news/local-news/oh-cuyahoga/doctors-on-the-streets-are-helping-clevelands-homeless
Ramirez, C., 2014
Arnquist, S. (n.d.). The Million Dollar (Homeless) Patient. Retrieved 10 21, 2015, from Reporting on Health: http://www.reportingonhealth.org/resources/lessons/million-dollar-homeless-patient