Category Archives: Homeless

Jan 2 2013
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Housing is Health Care

Kelly Doran, MD, is an emergency physician and a Robert Wood Johnson Foundation/U.S. Department of Veterans Affairs Clinical Scholar at Yale University. This post is part of the "Health Care in 2013" series.

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Around this time of year I think a lot about my friend Hank.  He is one of only two people to whom I reliably send a Christmas card each year, and just as reliably I receive a holiday package from him containing thoughtfully chosen gifts.

When I first met Hank he was homeless, living out of a van he parked near Golden Gate Park in San Francisco.  Hank had multiple serious chronic medical conditions, and the homelessness certainly did not help any.  He was very sick and, sadly, though he was barely 50 years old I thought he had maybe five years left, tops. Well, 10 years have passed and Hank is still ringing in the New Year… in his own apartment.  This is no Christmas miracle, but rather a predictable result of supportive housing.

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Mar 9 2012
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VA May Need to Do More to Help Women Veterans Who Are Homeless or At Risk for Homelessness, Study by RWJF/VA Scholar Finds

Oni Blackstock, MD, is a primary care physician and Robert Wood Johnson Foundation/U.S. Department of Veteran’s Affairs (VA) Clinical Scholar at the Yale University School of Medicine and the VA Connecticut Healthcare System. Her study, available online now and to be printed in the April issue of Medical Care, examines gender differences in the use of Veterans Health Administration specialized homeless services programs among Veterans of the conflicts in Afghanistan and Iraq, also known as Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF).

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Human Capital Blog: Tell us why you decided to look at this group of Veterans specifically. What makes them—and the time they are returning from service—unique from other Veteran cohorts?

Blackstock: I was interested in understanding use of VA homeless services programs among OEF/OIF Veterans for two primary reasons. The first reason is that many of these Veterans are returning to a country in the midst of an economic recession and housing crisis; therefore, characterizing use of VA homeless services programs among this group is particularly important. The second reason is that this group of Veterans has the largest proportion of women to serve and to be exposed to combat (about 12 percent of OEF/OIF Veterans are women). I wanted to know if women in this group of Veterans were using VA homeless services programs and how their use compared to their male counterparts.

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Feb 1 2012
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New Study Points the Way to Better Care, Improved Outcomes and Lower Costs for Homeless People with Chronic Conditions

By Laura Sadowski, MD, MPH, and Romina Kee, MD, Robert Wood Johnson Foundation (RWJF) Clinical Scholar alumnae

Becoming homeless is distressing for anyone, and it is especially challenging for people with chronic health problems who need ongoing care.

The face of America’s homeless population is changing. When the job market collapsed a few years ago, millions of families were forced out of their homes. A 2009 national survey of organizations providing services to the homeless found that an estimated 10 to 19 percent had become homeless in the past year due to foreclosure. Nearly one percent of the U.S. population experiences homelessness each year.

Previous research on the health/medical, legal, housing and social services costs accrued by people who are homeless has focused on subsets of the population—those with mental illnesses, substance abuse problems, or the “chronic homeless” (those who have been without stable housing for 24 or more months). But they comprise a small portion of America’s homeless population. The chronic homeless, for instance, represent just 18 percent.

So how do we ensure that all homeless patients – regardless of their individual circumstances – get the care they need, while reducing costs?

In our study published in a special edition of Health Services Research: Bridging the Gap Between Research and Health Policy, we looked at a novel, broader sample: homeless adults with chronic conditions. Unlike previous studies, the majority of our study subjects were not mentally ill, substance abusers, HIV infected, veterans, or frequent users of the health care system.

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Jan 6 2012
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Abject Poverty Affects Health

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As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Suzanne Gagnon, CFNP, RWJF Nursing and Health Policy Fellow, RWJF Nursing and Health Policy Collaborative at the University of New Mexico.

I live, work and study in a state that has one of the highest poverty rates in the nation. It is difficult for me as a nurse practitioner to focus my New Year’s resolution on the health care system. Yes there are health care system problems and complicated ones, but I cannot remove my gaze from the impact of abject poverty and its effects on health. Until New Mexico addresses its poverty, health care will continue to be a trailer indicator, not a primary factor for the state’s overall impact on quality of life.

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I work at a School-Based Health Center in a low-income area high school in Albuquerque. I have many patients who have no other means of receiving health care due to immigration status or income-related constraints. I had a student last year who had just moved to New Mexico from another state and wondered why the amount of food stamp assistance he and his mother received was so little in comparison to his previous state. He says: “I’m so hungry all the time, I can never get enough to eat, we don’t have enough to last all month. Why is it like that here?”

We are failing our children and families in fundamental ways. I cannot supply that child with enough food by making changes in the health care system, but eventually the effects of his hunger and poverty will affect the health care system. Currently his poverty and hunger are making a huge impact on his ability to succeed as a student. Elizabeth Bradley and Lauren Taylor nailed this topic in their December 8, 2011 New York Times article, ‘To Fix Health, Help the Poor.’ They pointed out the differences between our country’s investment in health care versus social support. While we spend one dollar on health care and 90 cents on social services, other countries spend the same for health care but double that for social services. Investing in social services can do more to improve health than additional health care reforms.

A December 29, 2011 op-ed in the Albuquerque Journal by Angela Merkert and Wendy Wintermute, respectively the executive director and advocacy program director of Cuidando Los Ninos and A Home for Every Child, lists the staggering statistics that impact our state’s homeless population:

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