Category Archives: Homeless
A comment period has just opened, through September 30, on proposed minimum standards for medical respite centers for the homeless. Medical respite centers provide an indoor, supported home where discharged homeless hospital patients can convalesce instead of immediately returning to the street.
Experts on homelessness says strong standards and compliance with them can result in not just reducing hospital readmission for discharged homeless patients, but also an increase in permanent housing solutions for people who entered the hospital without a place to call home. In fact, about 80 percent of homeless people who enter a respite facility move onto housing options instead of back to the street, according to Sabrina Eddington, director of special projects at the National Health Care for the Homeless Council (NHCHC).
Eddington says that having the standards in place is critical. An estimated 150,000 people who have no permanent address are discharged from the hospital each year, based on state estimates. Going back to the street can mean reinfection, hospital readmission and an inability to keep up with care, such as daily medication that could improve, stabilize and even cure both physical and emotional health problems.
Medical respite care centers range from free-standing centers to sections of homeless shelters, and even vouchers for motels and hotels with home visits by medical and social support staff.
The proposed minimum standards were published on September 1 and a comment period runs through September 30. The NHCHC will hold a webinar tomorrow, September 12, from 1-2:30 EST. Click here to register.
The goals of the guidelines for the respite care centers are to:
- Align with other health industry standards related to patient care
- Represent the needs of the patients being served in the medical respite centers.
- Promote quality care and improved health
- Create standards for a range of respite center types with varying degrees of resources
NHCHC has dozens of stories about previously homeless patients who were discharged to medical respite care and are now living in stable housing, often with no need for hospital readmission. Take Ahmed. After losing his family and business, Ahmed moved to the street, where he struggled with alcoholism and depression. In 2005, Ahmed had a stroke and was hospitalized. Following discharge he was back on the street until an outreach team brought him to a medical respite program, where he was medically stabilized; received help for his depression; and referred to a program that specializes in treating co-occurring mental illness and addiction. Ahmed is now in supportive housing and participating in a recovery program. He continues to visit his primary care clinic and psychiatrist and has not been hospitalized since the stroke occurred.
There are now dozens of medical respite facilities throughout the community, and NHCHC is hopeful about expanding the models.
“We advocate that medical respite services be available in all communities serving homeless clients,” said Eddington.
Earlier this summer, NHCHC was one of 39 Health Care Innovation Award recipients announced by the U.S. Department of Health and Human Services. The $2.6 million award is administered by the Center for Medicare and Medicaid Innovation and will be used to demonstrate improved health outcomes and reduced spending when homeless patients have access to medical respite care following a hospital stay. The three-year project will test a model that will provide medical respite care for homeless Medicaid and Medicare beneficiaries, following discharge from a hospital, with the goal of improving health, reducing readmissions and reducing costs.
Helping the Homeless Quit Smoking: Q&A with Michael Businelle and Darla Kendzor, The University of Texas School of Public Health
Not surprisingly, a recent study in the American Journal of Public Health found that homeless smokers struggle with quitting more than economically disadvantaged smokers who have their own housing. The study compared homeless smokers receiving treatment at a shelter-based smoking cessation clinic to people enrolled in a smoking cessation program at a Dallas, Texas, safety-net hospital.
“On average, homeless people reported that they found themselves around about 40 smokers every day, while the group getting cessation care at the hospital reported that they were more likely to be around three to four smokers every day,” said Michael S. Businelle, PhD, assistant professor of health promotion and behavioral sciences at The University of Texas School of Public Health Dallas Regional Campus, and the lead author of the study. “Imagine if you had an alcohol problem and were trying to quit drinking—it would be almost impossible to quit if you were surrounded by 40 people drinking every day. That is the situation homeless folks have to overcome when they try to quit smoking.”
Businelle said research shows that about 75 percent of homeless people smoke and that smoking is a leading cause of death in this population. And although homeless smokers are just as likely to try to quit smoking as are other smokers, they are far less successful at quitting, according to Businelle’s work. He said tailored smoking cessation programs are needed for homeless people, including smoke-free zones in shelters.
NewPublicHealth recently spoke with Businelle and his wife, Darla Kendzor, PhD, who is a co-author of the recent study on smoking and the homeless, as well as an assistant professor at The University of Texas.
NPH: Why did you embark on the study?
Michael Businelle: The smoking prevalence in this population is so high and homeless people are not enrolled in clinical trials so we don’t know what will work best for them. We’ve developed, over the last 50 years, really good treatments for the general population of smokers, but there are very few treatments that have been tested in homeless populations.
Darla Kendzor: And cancer and cardiovascular disease, which are in large part due to tobacco smoking, are the leading causes of death among homeless adults. So quitting smoking would make a big difference for them.
There are an estimated 7,350 homeless people living in San Francisco, yet there are only eight facilities in the city at which the homeless can shower. At each of these facilities, there are at most two shower stalls—meaning that there is at most one shower for every 460 homeless people.
Lava Mae developed a mobile approach to target this public health issue.
The refurbished San Francisco MUNI bus outfitted with two full-service bathrooms successfully made its first rounds on June 28. The bus will travel around the city providing the homeless with mobile public utilities and giving them much-needed access to clean water and sanitation. Without the limitations of stationary locations, Lava Mae is able to aide people across the city while also staying free from high real estate prices, rising rent and potential eviction.
"For at least a decade, bathrooms have stood in for the city's anxieties about homelessness, public utilities, and the changing economy," wrote Rachel Swan in a piece on public bathrooms in SF Weekly. Lava Mae founder Doniece Sandoval hopes that the program will take big steps in improving the health of the homeless and public sanitation by increasing the number and scope of available public restrooms.
The relationship between the health and wellbeing of the homeless population correlates directly with the health of the community as a whole. As the homeless population strives for a better quality of life, so does the community—one shower at a time.
Read the full story, “A Refurbished Bus Will Bring Showers to the Homeless in San Francisco.”
Evidence-based practices and model homelessness reduction programs that have been effective in other cities are the key tools behind a new initiative, the Mayors Challenge to End Veteran Homelessness, launched earlier this month by the U.S. Department of Housing and Urban Development (HUD) and the U.S. Department of Veterans Affairs (VA).
The goal of the Mayors Challenge is to end veteran homelessness by the end of 2015.Close to 60,000 veterans are homeless on any given night. Housing experts say the model practices and speed of their deployment can also serve as examples to greatly reduce homelessness in the general population—which can be as high as 3.5 million in any given year, according to HUD surveys.
Ending veteran homelessness has received increased attention in recent years. According to Eric Grumdahl, policy director of the U.S. Interagency Council on Homelessness, there has already been a 24 percent reduction in veteran homelessness in the last three years that is directly tied to evidenced-based practices, including:
- Housing First, a concept that eliminates prerequisites such as sobriety and minimum income before a veteran can be given housing.
- Permanent supportive housing, which adds mental health services.
- Rapid re-housing aimed at people who are homeless from time-to-time rather than chronically homeless.
San Diego and Phoenix were both recently cited by both HUD and the VA for effectively ending chronic homelessness among veterans.
In Phoenix, where one in five homeless adults was a veteran—about twice the national average—the city leveraged partnerships and local, state and federal funding to find housing solutions for veterans. Partnerships included state and federal government; the business and faith community; and non-profit groups. The city’s mayor, Greg Stanton, credits “a united front” and Housing First’s work to speed up placing veterans in safe housing.
A new survey from the U.S. Conference of Mayors released earlier this month found that in many U.S. cities homelessness increased by as much as 4 percent this year. The permanent solution to homelessness will require the concerted efforts of companies, communities, legislatures and individuals and includes affordable housing, jobs and economic policies and strong mental health support. That’s a lot to tackle, but there are some things individuals can do to make life a bit easier — and healthier — for homeless people in their communities.
Here are a few suggestions from online charitable giving site justGive.org, which has a full list of 35 ideas on its site:
- Buy Street Sheet or Street Sense: These biweekly newspapers are sold in almost every major American city and are intended to help the homeless help themselves by offering them economic opportunities and elevating their voices in the discussion on how to end homelessness. For every paper sold, the participants earn five cents deposited in a special savings account earmarked for rent.
- Bring food: When you pass someone who asks for change, offer him or her something to eat. If you take a lunch, pack a little extra. When you eat at a restaurant, order something to take with you when you leave.
- Give recyclables: In localities where there is a "bottle law," collecting recyclable cans and bottles is often a viable source of income for homeless people. It is an honest job that requires initiative. You can help by saving your recyclable bottles, cans, and newspapers and giving them to homeless people instead of taking them to a recycling center or leaving them out for collection (or, worse, not recycling at all!).
- Volunteer your professional services: No matter what you do for a living, you can help the homeless with your on-the-job talents and skills. Those with clerical skills can train those with little skills. Doctors, psychiatrists, counselors, and dentists can treat the homeless in clinics. Lawyers can help with legal concerns. The homeless' needs are bountiful — your time and talent won't be wasted. There are many different volunteer organizations through which you can channel your efforts.
- Volunteer for follow-up programs: Some homeless people, particularly those who have been on the street for a while, may need help with fundamental tasks such as paying bills, balancing a household budget, or cleaning. Follow-up programs to give the formerly homeless further advice, counseling, and other services — and are always in need of volunteers.
- Create lists of needed donations: Call all the organizations in your community that aid the homeless and ask them what supplies they need on a regular basis. Make a list for each organization, along with its address, telephone number, and the name of a contact person. Then mail these lists to community organizations that may wish to help with donations —from religious centers to children's organizations such as Girl Scouts and Boy Scouts.
- Help the homeless apply for aid - Governmental aid is available for homeless people, but many may not know where to find it or how to apply. Since they don't have a mailing address, governmental agencies may not be able to reach them. You can help by directing the homeless to intermediaries, such as homeless organizations, that let them know what aid is available and help them to apply for it. If you want to be an advocate or intermediary for the homeless yourself, you can contact these organizations as well.
- Read the full list of suggestions to help the homeless from justgive.org
- Read a NewPublicHealth post on the recent U.S. Conference of Mayors report on hunger and homelessness.
Unemployment and poverty top the reasons why homelessness and hunger continue to grow in the U.S., according to the U.S. Conference of Mayors 31st Hunger and Homelessness Survey, released yesterday. “There’s no question that the nation’s economy is on the mend, but there’s also no question that the slow pace of recovery is making it difficult and, for many, impossible, to respond to the growing needs of the hungry and the homeless,” said Tom Cochran, executive director of the Conference of Mayors during a conference call with reporters yesterday about the report.
The new report is based on surveys of city officials in the 25 cities that make up the Conference’s task force on Hunger and Homelessness, and all but one of the participating cities said requests for help had either gone up or stayed the same as the previous year.
Additional findings of the report include:
- The number of families and individuals experiencing homelessness increased across the survey cities by an average of 4 percent.
- More than one in five people needing assistance did not receive it because of insufficient city and donated funds.
- Because of the increase in requests many emergency kitchens and food pantries in the 25 cities surveyed had to reduce the amount of food provided to individuals or families.
One positive note in this year’s report was an increase in aid provided to homeless veterans because of targeted efforts by cities, the Department of Housing and Urban Development and the Veterans Administration. Eighty percent of the survey cities were able to find stable housing for some previously homeless veterans.
Many of the 25 survey cities addressed homelessness and hunger problems by adopting innovative programs specific to their communities to address and improve the situation. The Conference of Mayors report includes many examples both to highlight innovation and to serve as models for other cities working to improve the housing and food security conditions of their citizens:
As colder weather begins to set in, a new story on the homeless from Atlantic Cities is particularly striking: According to the U.S. Department of Education, the number of homeless students in the United States has hit a record high number.
For the 2011 school year—the latest year for which the department has data—1,168,354 homeless children were enrolled in U.S. schools from nursery through 12th grade. Nationally, that is a 10 percent jump over the previous school year, and a whopping 72 percent increase since the recession began in 2008. More striking numbers: more than 40 states showed a rise in homelessness among kids and ten states saw the number of kids without a space to call their own rise more than 20 percent since 2008.
The lack of a safe home and limited access to health care leaves America’s homeless at especially high risk for a large number of health problems. According to a fact sheet from the National Health Care for the Homeless Council, “Without homes, people are exposed to the elements, disease, violence, unsanitary conditions, malnutrition, stress and addictive substances. Consequently, their rates of serious illnesses and injuries are three to six times the rates of other people. These conditions are frequently co-occurring, with a complex mix of severe physical, psychiatric, substance use and social problems.”
>>Bonus link: Continue reading even after the numbers jump out at you to learn about a ten year old girl, reported by the San Jose Mercury News, who rides a bus with her father in Santa Clara County, Calif., each night since the $70 monthly pass makes it an affordable option. The fact that the young girl is having “one of her best years so far in school,” according to her father, is all the more remarkable considering they have to get off and reboard that bus about every two hours.