“Small infections on your foot might be able to be handled by just changing your socks, but when you [are not] able to wash in a bath or change your socks...they can actually lead to limb-threatening infections." Walter Coppenrath, Kaiser Permanente Doctor, UCLA mobile clinic volunteer
Homelessness and Healthcare
The homeless population has multiple health needs because of their higher rates of mental illness, substance abuse, and vulnerable position on the streets which exposes them to unsafe conditions. It is estimated that 40% of the homeless have some time of chronic health problem and 20 to 25% have some form of severe and persistent mental illness.
At the same time, they face significant barriers to health care: lack of transportation, lack of access to a telephone, lack of health insurance, and information poverty leave them unaware of the medical services available to them or unable to access them . In addition, many homeless persons are wary of the government in general, making them reluctant to apply for public benefits.
As a result of their lack of access to health care, particularly basic preventative care services, the homeless populations turns to the Emergency Room (ER) for treatment. A study of homeless populations in San Francisco showed they are three times more likely to utilize the ER than the general population, a figure that illustrates their lack of access to other non-emergency services. Similarly, a 1997 study of the L.A. homeless population found that only 57% had any contact with medical care, and of that number, 23% relied on the ER for regular medical treatment. And these visits are costly.
Each trip to the ER is about 3x the cost of a regular doctor visit. Moreover, repeated use of the ER for primary care services creates a financial and organizational hardship for hospitals that is felt by the public. When the homeless rely on the ER as their primary source of health care, they force hospitals to pick up the tab, raising the cost of health care, and increasing wait times for everyone.
The homeless population has multiple health needs because of their higher rates of mental illness, substance abuse, and vulnerable position on the streets which exposes them to unsafe conditions. It is estimated that 40% of the homeless have some time of chronic health problem and 20 to 25% have some form of severe and persistent mental illness.
At the same time, they face significant barriers to health care: lack of transportation, lack of access to a telephone, lack of health insurance, and information poverty leave them unaware of the medical services available to them or unable to access them . In addition, many homeless persons are wary of the government in general, making them reluctant to apply for public benefits.
As a result of their lack of access to health care, particularly basic preventative care services, the homeless populations turns to the Emergency Room (ER) for treatment. A study of homeless populations in San Francisco showed they are three times more likely to utilize the ER than the general population, a figure that illustrates their lack of access to other non-emergency services. Similarly, a 1997 study of the L.A. homeless population found that only 57% had any contact with medical care, and of that number, 23% relied on the ER for regular medical treatment. And these visits are costly.
Each trip to the ER is about 3x the cost of a regular doctor visit. Moreover, repeated use of the ER for primary care services creates a financial and organizational hardship for hospitals that is felt by the public. When the homeless rely on the ER as their primary source of health care, they force hospitals to pick up the tab, raising the cost of health care, and increasing wait times for everyone.
sources:
Caldwell, N., Srebotnjak, T., Wang, T., & Hsia, R. (2013). “How Much Will I Get Charged for This?” Patient Charges for Top Ten Diagnoses in the Emergency Department. Plos ONE, 8(2), 1-6.
DiPietro, B., Knopf, S., Artiga, S., & Arguello, R. (2012). Medicaid Coverage and Care for the Homeless Population: Key Lessons to Consider for the 2014 Medicaid Expansion.
Dunford JV, Castillo EM, Chan TC, Vilke GM, Jenson P, Lindsay SP. (2006). Impact of the San Diego Serial Inebriate Program on use of emergency medical resources. Ann Emerg Med, 47(4):328-336
Gallagher TC, Andersen RM, Koegel P, Gelberg L (1997) Determinants of regular source of care among homeless adults in Los Angeles. Med Care 35: 814-830
Kushel, M. B., Perry, S., Clark, R., Moss, A., & Bangsberg, D. (2002). Emergency Department Use Among the Homeless and Marginally Housed: Results From a Community-Based Study. American Journal Of Public Health, 92(5), 778-784
Morris, D. M., & Gordon, J. A. (2006). The Role of the Emergency Department in the Care of Homeless and Disadvantaged Populations. Emergency Medicine Clinics of North America.
Schanzer, B., Dominguez, B., Shrout, P. E., & Caton, C. M. (2007). Homelessness, Health Status, and Health Care Use. American Journal Of Public Health, 97(3), 464-469.
Caldwell, N., Srebotnjak, T., Wang, T., & Hsia, R. (2013). “How Much Will I Get Charged for This?” Patient Charges for Top Ten Diagnoses in the Emergency Department. Plos ONE, 8(2), 1-6.
DiPietro, B., Knopf, S., Artiga, S., & Arguello, R. (2012). Medicaid Coverage and Care for the Homeless Population: Key Lessons to Consider for the 2014 Medicaid Expansion.
Dunford JV, Castillo EM, Chan TC, Vilke GM, Jenson P, Lindsay SP. (2006). Impact of the San Diego Serial Inebriate Program on use of emergency medical resources. Ann Emerg Med, 47(4):328-336
Gallagher TC, Andersen RM, Koegel P, Gelberg L (1997) Determinants of regular source of care among homeless adults in Los Angeles. Med Care 35: 814-830
Kushel, M. B., Perry, S., Clark, R., Moss, A., & Bangsberg, D. (2002). Emergency Department Use Among the Homeless and Marginally Housed: Results From a Community-Based Study. American Journal Of Public Health, 92(5), 778-784
Morris, D. M., & Gordon, J. A. (2006). The Role of the Emergency Department in the Care of Homeless and Disadvantaged Populations. Emergency Medicine Clinics of North America.
Schanzer, B., Dominguez, B., Shrout, P. E., & Caton, C. M. (2007). Homelessness, Health Status, and Health Care Use. American Journal Of Public Health, 97(3), 464-469.