Accessing Healthcare While Chronically Homeless
“People should not be allowed to die from illnesses that are preventable and treatable. We have to come together to lower barriers,” shared Nancy Richman, Project Director of HealthNet Bloomington Health Center, at the recent Wake Up! with United Way.
Other panelists speaking on the topic of “Accessing Health Care While Chronically Homeless” at the May 13th event included Jean Capler, LCSW, Local Support Network Leader of the Rehabilitation Hospital of Indiana Resource Facilitation Program; Dana Jones, Director of the Wheeler Mission Bloomington Center for Men; Greg May, Administrative Director of the Centerstone Adult and Family Services; and Meredith Short, Outreach Coordinator at IU Health Positive Link.
According to the U.S. Department of Housing and Urban Development, “people living in shelters are more than twice as likely to have a disability compared to the general population. Conditions such as diabetes, heart disease, and HIV/AIDS are found at high rates among the homeless population, sometimes three to six times higher than that of the general population.”
The average age of death of a chronically homeless individual is only 47 years old and “it's often for medical conditions that are treatable and preventable – like high blood pressure, diabetes, heart disease. Those are all things that we know improve when people have access to primary care,” according to Greg May. “And having that connection – that trust – built between the person and the provider or the person and the outreach team is primary and essential in keeping people connected to services that work.”
“Complex and chronic medical problems for people experiencing homelessness are often compounded by brain injuries, mental illness, substance use disorders, and so forth,” Nancy Richman remarked. “Often medical issues seem less important than the priorities of finding shelter, food, and clothing, and medical issues are left until they become emergencies. Some of what we need to address is building trust – building those relationships. That's the earlier issue before you even get to healthcare access.”
Building trust is an essential component to providing healthcare – and panelists emphasized that it is critically important in providing care for people experiencing homelessness. Additionally, outreach, collaboration, transportation, follow-up systems, and lowering barriers for service are key to ensuring care.
Richman also shared that HealthNet is currently working to establish on-site mini-clinics at local shelters and street medical care, ideally including street psychiatry, to lower the barriers of access.
“Most studies are showing about 40-50% of folks utilizing emergency shelter have a history of at least one brain injury. Maybe it was abuse during childhood, maybe it was a car accident, maybe it was an assault. And 70–85% of folks who are homeless experienced a brain injury before their first bout of homelessness. So, it can be a contributing factor leading to homelessness. Many times, they don't recognize they've had brain injuries and never got medical attention,” shared Jean Capler. “If you've got a brain injury it can affect your cognitive function – to put together a plan, a strategy, for accessing health care. Maybe you forget your appointment and if you forget too many appointments some health providers will say you can't return. And that is a chronic issue for folks with brain injuries.”
Meredith Short spoke about the outreach efforts at Positive Link. “We realized that when people are newly diagnosed, they might need extra support or there are people who have fallen out of care, often because they're experiencing houselessness. We have specific people on staff who go find people if they're in their camps or at the shelter and provide extra support. This has been super helpful to make sure that people are getting access to health care."
Meredith also commented on the strong spirit of collaboration in Bloomington. “Within the last few months, a lot of the outreach workers in Bloomington have started meeting monthly to communicate about what we're doing. This has been extremely helpful. People from the Bloomington Homeless Coalition and a variety of places attend, and it helps us figure out what some of those gaps and services are.”
In closing, Dana Jones reflected, “We are a compassionate community. A lot of people want to help but there is a stigma with mental health. I love the saying, ‘Love your neighbor.’ If this person was you, how would you want to be treated? How do we come alongside someone who is extremely different than we are? How do we come along someone who acts different than we do? How do we reduce that stigma around homelessness and the stigma around mental illness so that we can engage with people as human beings, as fellow neighbors in our community, and not as statistics? If we can engage on a level of, ‘This is my neighbor, I want to show concern for this person, and build a personal relationship with them.’ Loving your neighbor is a great way to begin.”
Watch the event video below.
- National Alliance to End Homelessness
- Brain Injury Association of Indiana
- Traumatic Brain Injury Factsheets | Model Systems Knowledge Translation Center (MSKTC)
- Resources and services for people living with brain injury
- Centerstone Website
- HealthNet, Inc. Website
- IU Health Positive Link
- Rehabilitation Hospital of Indiana Resource Facilitation Program
- Wheeler Mission Website
- United Way Housing Insecurity Collaboration Interest Form
Speaker Contact Info:
- Jean Capler, MSW, LCSW, CBIS; Local Support Network Leader for RHI Resource Facilitation; 812-325-0885; email@example.com
- Dana Jones; Director, Center for Men at Wheeler Mission; DanaJones@wheelermission.org
- Greg May, MS, EdD, MSW; Director, Integrated Health at Centerstone; Gregory.May@centerstone.org
- Nancy E. Richman, Ph.D., MPA; Project Director at HealthNet Bloomington Health Center; Nancy.Richman@indyhealthnet.org
- Meredith Short, BSW; Outreach Coordinator at Indiana University Health Community Health; firstname.lastname@example.org
40-50% of people experiencing homelessness have a history of brain injury, and of those people, 70-87% of them experienced the brain injury BEFORE their first experience of homelessness.
- Hwang, SW, Colantonio, A., Chiu, S., Tolomiczenko, G., Kiss, A., Cowan, L., Redelmeier, D.A., and Levinson, W. (2008). The effect of traumatic brain injury on the health of homeless people. Can. Med. Assoc. Journal, 179(8): 779-784.
- Topolovec-Vranic, J, Ennis, N., Howatt, M., Ouchterlony, D., Michalak, A., Masanic, C., Colantonio, A., Hwang, S., Kontos, P., Stergiopoulos, V., Cusimano, M. (2014). Traumatic brain injury among men in an urban homeless shelter: observational study of rates and mechanisms of injury. CMAJ Open, 2(2): E69-E76. Retrieved 9/25/15 from http://www.cmajopen.ca/content/2//E69.full.pdf+html
- Topolovec-Vranic, J, Ennis, N., Colantonio, A., Cusimano, M., Hwang, S.W., Kontos, P., Ouchterlony, D., and Stergiopoulos, V., (2012). Traumatic brain injury among people who are homeless: a systematic review. BMC Public Health, 12:1059.
- 25% of the homeless population in the US has some form of severe mental illness vs. 6% of the general population. Source: National Coalition for the Homeless. (2009). Mental Illness and Homelessness. MentalIllness-fs0809.doc (nationalhomeless.org).
- 38% of homeless people were dependent on alcohol and 26% on other substances, compared to 8.4% of general pop. Source: National Coalition for the Homeless. (2017). Substance Abuse and Homelessness. Substance Abuse and Homelessness.docx (nationalhomeless.org)
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Wake Up! with United Way is a collaborative project of United Way of Monroe County and IU’s Political and Civic Engagement Program. The series is made possible by the following sponsors:
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