Why it should bother YOU that a person who is homeless cannot get medical care

A clinic waiting room is shown at Cooper Green Mercy Hospital in Birmingham, Ala., Friday, March 23, 2012. (The Birmingham News/Mark Almond)

Cooper Green has not left the headlines since Inpatient Care and the Emergency Room were closed last year. A large physician’s group is now speaking out about poor people not receiving medical services — a situation they say will raise medical costs for everyone.

However, a recent scholarly article published in the Journal of Urban Health tells an equally frightening story….a story that has been going on for more than 10 years.  The following news articles are as recent as April 26, 2013:

The Journal of Urban Health tells us that in 2010, a group of researchers set out to understand more about a previous study showing that the homeless of our community have problems accessing medical care. The 2010 study showed:

  1. that the problems with getting care are real and that they remain severe

  2. that problems pertain to all types of health care, even the most basic general care that charity clinics and federally qualified health centers get funds, grants and donations to provide

  3. that the problems with getting care are especially difficult at the federally funded Birmingham Health Care, and at the primary care clinics at Cooper Green

The study shows that 15% of homeless people who went to Birmingham Health Care could not get care, and that, at the Cooper Green clinics, 13% could not get care. The study shows that, from 1995 to 2005, the percentage of homeless persons in Birmingham with unmet health care needs rose from 32% to 54%, meaning that on at least one occasion, these individuals were unable to access a form of health care they needed even though they tried.

Why should it bother YOU that a person who is homeless cannot get medical care? Well, first thing is that One Roof believes it is morally the right thing to do to see that basic medical care is provided for ALL citizens. Additionally, it is fairly disturbing that we live in one of the arguably greatest medical centers anywhere, and people who have lived here for their entire lives cannot access basic medical care.  However, if you don’t care about those reasons, let me share another reason:  money. The links below are just three short articles out of the hundreds of studies that show routine care for chronic conditions is far less expensive than emergency care.

The bottom line of all these studies is that medical costs incurred when getting routine medical care in a doctor’s office or clinic setting are much, much lower than going to the emergency room. Logically, a person who is unable to receive the needed routine care in a clinic is unlikely to be able to afford the emergency room care. If the emergency room care is not paid for by the patient, the unpaid cost will somehow be passed on to other hospital patients…that means you and me.

Ok, so non-emergency care is cheaper than emergency care. So why doesn’t everyone use the doctor’s office or clinic instead of going to the emergency room?  What if you can’t, as most homeless people can’t, afford that non-emergency care?  The safety net in place is a Federally Qualified Health Center or FQHC.

What is a FQHC? A FQHC serves as the medical home and family physician to 15 million people nationally. FQHC patients are among the nation’s most vulnerable populations with about half living in economically depressed inner city communities. Nearly 70% of FQHC patients have family incomes at or below poverty. Nationally, 40% of FQHC patients are uninsured and another 36% depend on Medicaid, much higher than the national rates of 12% and 15% for the nation’s population as a whole. Two-thirds of health center patients are members of racial and ethnic minorities.

Where are the FQHC’s for the majority of this area’s homeless population?

According to the U.S. Department of Health and Human Resources Health Resources and Service Administration, Birmingham Health Care is the FQHC for this area. But remember, the study published recently said that it has been increasingly difficult over the past few years for the homeless to access health care at Birmingham Health Care. If it is difficult for the homeless people to access health care at Birmingham Health Care and at Cooper Green, doesn’t it stand to reason that these sick people will probably end up in an emergency room? If asthma is not controlled with routine medications, permanently damaged lungs and frequent hospital visits can result. If high blood pressure is not controlled, congestive heart failure can be the expensive consequence. If an abscessed tooth is not removed, bacterial endocarditis (a heart infection) can happen. Let’s not even go into the myriad of problems that result from uncontrolled diabetes.

To add another layer to this complex problem, homeless people have more medical problems than housed people. Really?

Yes, really, according to the above studies and articles. It makes sense that the common cold is easier to treat in your own home, on your own couch, with your own chicken soup, than if you are under the interstate, on your own concrete, with nothing to eat.  It only stands to reason that asthma is easier to treat if you have your own home, with your own inhalers and an ability to close the windows to the dust and pollen, than if you are on the streets, with no medications, and no doors, windows or walls to close to anything. If homeless people have more medical problems than housed people, they will need more medical care (or we could just house them, but that is a whole other story).

Back to the headlines…reduced access to medical care for our homeless population. Let’s believe that people with understanding of medicine, poverty, business, and the intersection of the three will step up and figure out how to wisely use the resources of our community to provide the care that area citizens deserve…whether that care is seen as a moral obligation or a financial imperative.

For more information about area homelessness, please feel free to review previous articles on our blog or take a look at our Point in Time information.

 Michelle Farley, Executive Director

10 Reasons to Volunteer for Point in Time

Do you want a good reason to register and volunteer for Point in Time?

Each year, One Roof must conduct the Point in Time count — a mini-“census” of our homeless population.  This count is impossible without your help, and it is vitally important to preventing and ending homelessness in Birmingham.   Here are 10 reasons to volunteer.

1.  You live in – and care about – Birmingham.
Cities with high rates of homelessness are generally not thought of as thriving, healthy cities.  But how can you tell the health of your city if you don’t know the facts?  How will you know if the state of homelessness is improving or getting worse?  By volunteering for Point in Time, you can be part of the reason Birmingham can thrive, grow, and become a healthier, happier community for people to live.  When you collect data about our homeless population, you ensure that the knowledge, plans, and resources are there to end homelessness in the most effective way possible.

2.  You care about homelessness.
Many of us have known someone who is homeless, and this is because homelessness is something that can happen to anyone.  It is difficult to see a loved one or friend struggle with homelessness and all the obstacles associated with it.  And if you have personally experienced homelessness, you are aware of how many misperceptions there are about people facing homelessness.  Volunteering for Point in Time is a smart volunteer opportunity that is not only educational, but it gives visibility to a population whose needs and very complex situations are often overlooked.  By interviewing participants in the Point in Time survey, you allow someone to tell their story, acknowledge that there are often systemic problems that keep people homeless, and find out more about what you can do to prevent and end homelessness in the future.

3.  You’re the adventurous type.
Point in Time is, in and of itself, a kind of adventure.  Volunteers work in teams all over downtown Birmingham.  Especially at night, volunteers conduct interviews on foot and actively search for participants.  We’ve often heard volunteers report that this was certainly a unique experience — both for the places they’ve gone and the interviews they’ve conducted.  A great deal of the Point in Time experience is brand new to those who volunteer with us.   Both experienced and new volunteers tend to meet new people and learn new things about Birmingham and homelessness that they’ve never known before.

4.  You’re a fan of urban exploring.
When conducting the night count during Point in Time, volunteers look for participants by walking the metro-Birmingham area in a grid.  This ensures that we have an accurate idea of who and how many are homeless in our community, but it also means that if you like exploring, you will definitely see Birmingham in a way you haven’t seen it before!  For volunteers who are on a street team, it is sometimes necessary for us to climb up under interstates and bridges, walk through parks, (structurally safe) abandoned buildings, and other places in order to conduct an interview.

If you’re worried about safety — don’t worry!  We take every precaution to make sure volunteers are safe.  You’ll never be alone and we have experienced team leaders to help when you’re unsure.  (If you’re NOT into urban exploring, the day count might be more appropriate for you!)

5.  You need to volunteer for a class or group.
In the past, many PIT volunteers were able to get documented volunteer hours for their time with our organization.  What’s great about Point in Time is that it is a 24 hour count and you can register for the hours that work best for you!  AmeriCorps members can receive service hours and we encourage university clubs, sororities, fraternities, churches, offices, and other groups to participate in Point in Time together.  That way you can volunteer with your friends, meet any requirements requested by your affiliated group, and we always try to make your volunteer experience as convenient, safe, and pleasant as possible!

6.  You like meeting new people.
Do you like learning about people, finding out their stories, or enjoy striking up conversations with people you’ve never met before?  People from all walks of life become homeless.  Because Point in Time is a collection of surveys, volunteers are meeting and talking to new people all day long!  On top of that, One Roof does not discriminate (except for age – you must be at least 18 years old!) when it comes to recruiting volunteers for Point in Time.  That means there are MANY different kinds of people with all kinds of different experiences and backgrounds for you to meet!

7.  You care about social issues.
Homelessness is a very complicated issue where a circumstance (homelessness) is often mistaken for the identity of a person.  Quite often there are prejudices against those who are homeless that can prevent them from leaving homelessness.  Sometimes those prejudices are tied to issues of class, gender, race, ethnicity, or perhaps other social stigmas.  All social issues are worth thinking about as they relate to homelessness;  becoming a volunteer for Point in Time is one way to make sure you know why people are homeless and who is homeless.  It’s also a way combat social justice issues that might concern you.  By counting their voice, you give their circumstance visibility and make their needs known.

8.  You’ve never experienced homelessness or spoken to someone who is homeless.
Perhaps you’ve never spoken with someone who is homeless before.  Because of that, maybe you’re unsure why people become homeless.  Conducting an interview during Point in Time acts as a structured conversation, and usually allows a very different perspective to take place than volunteers have had before.  This is a unique opportunity to see homelessness in a new light and to learn more about the extent of the problem and why it happens.

9.  You’re interested in or considering a career in social services.
Social services are incredibly important to preventing and ending homelessness.  Mental illness, health conditions, and other complications have a staggering impact on the lives of many individuals — sometimes resulting in the inability to maintain a place to live.  If you’re interested in social services, volunteering for Point in Time will increase your familiarity with homeless service providers in Birmingham, allow you to see what field work is actually like, and volunteer in a way that serves an issue that you’re passionate about.

10.  You are frustrated, conflicted, or confused about the social services and resources being used in Birmingham.
PIT counts are just one way that we can cut down on the duplication of services in our community.  By having a better idea of exactly who is homeless, understanding why they are homeless, how many are homeless, and what they need to leave homelessness, we can  make sure that resources are used in the most effective way possible to reduce the rate of homelessness.  This means assisting individuals so that they leave homelessness forever and make sure that people are not stuck in the a cycle of homelessness. It also means being smarter about how we help people in a way that positively changes their lives — permanently.

* * *

This e-mail is to invite you to register as a volunteer for our upcoming event, Point in Time, which will take place on the evening of January 22, 2013, and during the day onJanuary 23, 2013.

We hope you’ll join us.  Click below to learn more and to register as a volunteer on our website:


Remember we’re always thankful for individuals or groups of people!  If you belong to a church, organization, school, or other group, we’d love to have you join us.
If you’re not sure, follow us on Facebook and stay on our mailing list.  You can always call or e-mail our office if you have any questions or concerns about Point in Time.

Choosing to be homeless

There have been several items in both local and national news lately regarding homeless people who stay homeless because “it is their choice.”  Choice is many things to many people….telling a child they can either eat their brussel sprouts or their boiled okra is giving them a choice, but what kind of choice is it?  Being told you can either take your younger brother with you on your date with the cutest person ever or you can stay home, is being given a choice, but who wants to make that kind of choice?  Being homeless “by choice” is a far more complicated and life altering decision than choosing one stinky green thing over another stinky green thing, but unless you have experienced the need to make that choice, how do you possibly understand? One of my first “aha moments” came just a few months into taking this position at One Roof. January 2004 was the first Point in Time survey I experienced, and it truly was a learning experience.

What is Point in Time?  Think mini-census when just people who are homeless are being counted. One Roof staff (in 2004 that was me, and only me) plus many, many community volunteers blanket soup kitchens, shelters, downtown streets, camps in the woods and abandoned buildings in an attempt to speak briefly with every single homeless person in our three-county coverage area (Jefferson, Shelby and St. Clair Counties). That group of passionate volunteers works with a pre-printed list of questions regarding age, gender, race and things like how long a person has been homeless. This is a monumental undertaking considering the geographic coverage area, misperceptions about people experiencing homelessness, the reluctance of some homeless people to interact with the general public, and the number of people homeless in our area on any given night. In 2004, that number (just in case you are interested) was more than 2,500. In January 2012, that number was just slightly more than 1,700.  So we really are making progress on housing people, it is just a lengthy, complicated process.

But you started reading because you wanted to know why someone would choose to be homeless…I’d like to share what I learned that cold, damp (pretty yucky, actually), day in January 2004. I was in one of our beautiful City parks with my survey, a little bit nervous because I didn’t want to offend anyone by incorrectly assuming they were homeless, and I tentatively spoke to a man with several layers of clothing and a dirty backpack. He confirmed that he was indeed homeless when I asked for a moment of his time. He politely answered all of the basic questions that were on my sheet, and then I asked him if there was something that kept him homeless. Even though I was new to the community of people working to end homelessness, I at least understood that mental illness and substance abuse are two big challenges in our area, but he denied having either of those disabilities. He told me that he had severe sickle cell anemia.  The weather was bad and only going to get worse, so shouldn’t he go to a shelter immediately? I asked.

This very patient man took the time to explain to me that when he stayed in one of our shelters, even though workers always tried to do their best for him, he would end up hospitalized with a sickle cell crisis each time. Emergency shelters are congregate living facilities (think about all the pictures you’ve ever seen of army barracks), and any germ spreads like wildfire, and no matter how much he tried to keep away from other men, the living space was just too tight. He calmly told me that he chose to stay on the street and take his chances against the weather rather than go into a shelter and fight the germs he knew were there.

What a choice…bed down outside in Alabama’s January weather and stay out of the hospital, or go into a place for a hot shower and a soft bed and end up hospitalized with debilitating pain, the need for blood transfusions, and the possibility of losing your life.

We need your help for this year’s Point in Time survey. Our community needs to learn what changes have taken place in our homeless population since last year. What would you like to learn?

Please contact Stacy Oliver to learn more about Point in Time and to get scheduled for training. We need your help! volunteer@OneRoofOnline.org or 205.254.8833.   To find out more or to register online, please visit this page.

On behalf of the One Roof team, we’d like to wish you a happy holiday season.  We hope we can count on seeing you in the new year!


Michelle Farley,
Executive Director of One Roof

Volunteer Now to help end homelessness
Get help addressing a homeless situation

One Roof Events