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

The underlying issue: One Roof’s response to publicity surrounding Cooper Green & Birmingham Health Care

September 9, 2012:
From Executive Director, Michelle Farley:

It is official: the decision has been made to shut down some of the medical services provided by Cooper Green Mercy Hospital. Time may be spent fighting this move, and the decision may even be reversed. For now, though, it looks like the hospital beds and the emergency room that feeds the hospital beds will close. One Roof takes no position on this issue, but we do want to advocate for the people that will be affected by that decision.

On Tuesday, September 11, there were 41 patients in hospital beds according to Cooper Green officials. Our question is this: could hospitalization have been prevented for any of those patients if they had been able to get regular, routine medical care? Were some of these patients hospitalized for heart failure related to an inability to access basic, inexpensive medications? Were some of these patients hospitalized for pneumonia, when their sickness began while living under the interstate trying to treat the flu? Were some of these patients hospitalized for complications with diabetes because they had no regular access to nutritionally-balanced foods?

Perhaps One Roof is simply dreaming, but we would like to propose that the community take this opportunity to evaluate the delivery of medical care for the poor, the homeless, and the underinsured people of our community. What can we do to improve access to medical care rather than continue to chart the decline of said access? How could we make certain that, in a city with limited public transportation options, everyone could travel to a doctor for routine, preventive medical care? How could we assure those living on very limited incomes, particularly the very common disability payment of $698 per month, that even if they don’t have the $4 or $5 or $10 to spend for a generic medication to keep them healthy, those medications would be provided for them? Perhaps if we could keep people healthier, we could reduce the need for expensive hospitalization. Perhaps if we could reduce the number of expensive hospitalizations, more funding would then be available for more outpatient services. Perhaps One Roof is dreaming, but we believe that Birmingham has too many world class physicians, too many nationally ranked medical programs, and too many caring people for the poor and the homeless to go without basic health care.

August 27, 2012:

Recently there has been an increase in media attention and public concern surrounding Cooper Green Mercy Hospital and Birmingham Health Care. Both facilities serve some of the indigent and homeless in our community, and both provide some access to healthcare that these populations might not otherwise have. Because Birmingham’s homeless are of utmost concern to One Roof, we would like to encourage the community to look at the underlying issue when considering the publicity associated with Cooper Green and Birmingham Health Care: the very serious lack of care available to the most vulnerable in Birmingham.

For most of us, when we are sick or have health issues that are cause for concern, we know which doctors to see and where we can see them. We schedule an appointment, and though we may gripe at the amount of time being cut out of our schedules, we typically spend no more than three hours in the doctor’s office. We see a general practitioner, an internal medicine physician or even an urgent care clinic (Doc in a Box). We see a specialist or go to the high-cost emergency room only when absolutely necessary. Whether we suffer from a chronic disease or a temporary illness, most of us can access the medications we need to maintain our health or to heal faster from a nasty, but brief condition. Health care isn’t easily available to everyone, and of course there are instances where even housed individuals cannot afford the cost of some medications or procedures that may be desperately needed – but most people can make the sacrifices necessary to obtain care that will save their lives. Furthermore, many of us in Birmingham are lucky enough to have secure employment that permits us the time to heal and recover from our illness without the threat of losing our source of income (whether for the few days we are sick, or indefinitely). Many of us have our own cars, which are necessary for seeing our doctors, who then tell us to see our specialists – while only missing a minimal amount of work.

But what about those among us who cannot afford a place to sleep at night, let alone medications to manage high blood pressure, a mental illness, or other life-impacting conditions? Or those whose combined financial situation and serious health issues cause them to slip into homelessness in the first place? Often, individuals who are struggling financially and who are employed do not have flexible schedules that can allow a full day devoted to waiting for a doctor’s appointment, which is often the case in free health care situations. This is often combined with the time it will take to work around Birmingham’s less than perfect transit system. When illness interferes with work for such individuals, it is only exacerbated by putting off getting care and rest. And for those who have serious chronic illnesses, such as cancer, homelessness can pose a serious threat to their chances of recovering, and certainly to their chances of having any comfort or relief while they are sick. In Birmingham, homeless persons face a serious lack of accessible preventative care and other medical options. 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. One Roof is concerned because that number has risen and may continue to rise in coming years.

For Birmingham’s homeless, inability to pay for health care, not having an access card to a particular facility, transportation problems, having to wait too long to be seen in a clinic situation, and simply not knowing where to receive care, are all barriers to receiving health care. Furthermore, because there are few accessible clinics or outpatient services that are free of charge, there is an overwhelming misuse of hospital emergency rooms. In a survey conducted in 2010, the three facilities that homeless persons reported they sought health care from the most were Cooper Green Emergency, Birmingham Health Care, and UAB Emergency. Not only are emergency room visits costly, but they are often inappropriate for the care that homeless citizens actually need, and ER visits are often preventable by the utilization of other health care options. For example, someone with a heart condition could avoid repeated visits to the emergency room and an exponential decline in health if they only had regular access to their inexpensive, generic heart medication. Also in 2010, 66% of participants reported that they required medication since becoming homeless. In the same study, at least half of homeless persons surveyed said they had difficulty accessing specialty medical services, mental health services, dental services, and medications. 46% of homeless persons surveyed said they had difficulty accessing a general health practitioner. With few outpatient resources available to homeless individuals with no income and no insurance, it is understandable that some utilize emergency services for simple, primary health care.

As it stands, Cooper Green and Birmingham Health Care each serve some homeless people. There are other, less mentioned organizations that work diligently in Birmingham to provide health care options for homeless individuals who desperately need their help, such as M-Power Ministries, Cahaba Valley Health Care, and Christ Health Center (Woodlawn). But there is also a huge gap in services, and this lack of medical access helps keep people in homelessness. Poor health is a barrier to progress for anyone, but for homeless persons it can have much longer-term, imminent, and grim repercussions. How do you get a good night’s restorative sleep when you are in a communal shelter, or even worse, sleeping under the interstate? How do you avoid commonly transmitted illnesses like the flu when you have no place to wash your hands? How do you prevent everyday skin infections when you have no place to shower or bathe? How do you control your heart disease or your diabetes when you must eat, if you want food, the calorie-rich offerings at the soup kitchen or shelter? And if you are employed and have little access to health care, what can you do when your health interferes with your work?

Programs and agencies affiliated with One Roof, such as The Nest, UAB Community Psychiatry, the VA Medical Center, JBS Mental Health Authority, and others, all provide free or low cost assistance to some of our homeless. One day each year, One Roof co-chairs Project Homeless Connect, which offers homeless clients the opportunity to access a free check-up, HIV screening, medication, prescription eye glasses, and dental extractions (in 2012, more than 700 clients attended PHC). But the need in our area is too great and there are still massive gaps in health care accessibility.

There are steps you can take to help this issue and to help make our community itself healthier and happier. You can support agencies that reduce a homeless person’s dependence on emergency services. You can offer philanthropic and political support for programs and representatives who can offer or see the need for homeless medications, more outpatient services, and other free health care options that can offer preventative care. You can support programs, organizations, and representatives who see the need to improve our public transit system. You can also inform others that existing needs in our community are not being met by existing services when this common, but incorrect, assertion is made.

For more suggestions for how you can help or for more information on this issue, please feel free to call or e-mail us at One Roof (info@oneroofonline.org , 205.254.8833).

National Alliance to End Homelessness

Two One Roof team members attended the National Alliance to End Homelessness annual conference (July 16 – 18, 2012).  Presentations from that conference are now available online and offer a number of great resources and ideas for improving our continuum.  Click here.

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