homeless

Accidents Will Happen: The Need for Respite Care in Central Alabama

Firehouse accident 5.28.14

                                                                                                                                                            (photo courtesy of al.com)

There was a car accident in front of the Firehouse Shelter this morning and four men were injured in that accident. Of course my first thought was hope that everyone involved will be ok…but when I learned that the four men had been taken to the hospital, I began to wonder about something else–something I might not have been concerned about had the four men not been standing in front of an emergency shelter for men.

If their injuries are severe, where can they go for rehabilitation?  You see, we really don’t have many choices for people who are homeless when they are not sick enough to keep in a hospital but yet they are too sick to release them to the streets.

I don’t know yet about the extent of injuries for these men, but I have been informed that 3 of the 4 will need surgery. I’ve had two fairly major surgeries in my life; one was outpatient and the other required several days of hospitalization. For the outpatient surgery, I couldn’t be released without someone to “take me home.” When I got home, I went to bed and for several days afterwards had someone help me with basic living skills like bathing and preparing meals. With the inpatient surgery, the release was much the same…hospital released me to go home and rest and I was only released because I had someone at home who could care for me. I was lucky enough to have plenty of medical insurance, but what if these men don’t?  Hospitals can not afford to keep uninsured people indefinitely.

What happens for these men who probably call the Firehouse Emergency Shelter home? None of our emergency shelters are set up to accommodate much in the way of specialized medical care…not really even extended “rest.” There are individual beds for clients, but they are not in individual rooms, and sleeping in a common area with 50 or so other people in crisis really doesn’t contribute to a great deal of rest. Our local shelters make certain clients are offered 2 – 3 meals per day, but there is no one to prepare special meals. In several of our emergency shelters, volunteers prepare a meal for 50+ people and bring it to the shelter, and while that is generally a tasty meal, clients are certainly not asked what their taste preference is for that meal, and few individual dietary restrictions are observed.

With each of my surgeries, I was instructed to keep the incision “clean and dry,” and doing that required assistance to keep the dressing dry when I bathed and required assistance to change the dressing when necessary. Again, our emergency shelters are simply not equipped with extra staff members to help with bathing or changing a dressing. It is not because shelter staff don’t want to help, but they are responsible for the care and safety of 50 or more people at any given time…

Our community needs emergency shelters…but we also need something called Respite Care, and we have none. Consider taking a look at Center for Respite Care or this medical journal article or this Respite Care in Philadelphia, or this piece from the University of California.

Until we get Respite Care here, my sincere hope is that you will think about a time you needed extra attention when you were sick, whether that was with an accident or a surgery or just a nasty cold. Now focus those thoughts and feelings on the situation of these four men at the Firehouse Shelter…

One last thing…think about what our community could look like if there was a home available for everyone who wanted one…

 

Michelle Farley

Executive Director, One Roof

Ending Veteran Homelessness at 7th Annual Project Homeless Connect

veterans

On April 5, 2014, One Roof, the City of Birmingham, Hands On Birmingham, the United Way of Central Alabama, and 65+ agencies collaborated at Boutwell Auditorium to provide services at our city’s 7th Annual Project Homeless Connect. On one day, with one goal, under One Roof, more than 1,000 community members came together to strategically end homelessness.

Project Homeless Connect (PHC) is a national best practice utilized in many cities across the United States and is also an important part of our community’s plan to end homelessness.  Since 2008, guests of PHC have had access to state ID (a necessary document for applying for housing or employment), medical and legal services, grooming services, housing services, and more. At this year’s PHC, One Roof took to heart the call of the Department of Housing and Urban Development (HUD), the US Interagency Council on Homelessness, US Department of Veterans Affairs, and the National League of Cities to end Veteran homelessness by 2015.

The following agencies came specifically to assist Veterans struggling with homelessness in central Alabama: three SSVF (Supportive Services for Veterans and Families) participants: Hope for Heroes (Aletheia House), Family Endeavors, and Priority Veteran (United Way); one Department of Labor employment grantee, Jobs for Vets (Aletheia House); several VA Hospital programs and services: Homeless Intake, HUD-VASH, CWT (Compensated Work Therapy), SE (Supportive Employment), HVSEP (Homeless Veterans Supportive Employment Program), Grant and Per Diem Housing, and Phoenix Clinic.

Of the 921 total community members in housing crisis who attended PHC, nearly 20% were Veterans. Of those Veterans, 51 were chronically homeless, meaning they have a disabling condition and have been literally homeless for a year or longer or have experienced homelessness four or more times in the past three years. These 51 Veterans represent nearly one-quarter of all chronically homeless clients served at PHC on April 5.

One Roof believes that each Veteran in our community deserves stability and a safe, decent, and affordable home. These folks served to make our community, our country, and our world a safer, better place. In return, One Roof believes that we can make our community a safer, better place for our Veterans.

Project Homeless Connect is a life-changing event in our community that is made possible by the collaboration of many service providers to make sure that anyone who is homeless in central Alabama can have access to the tools and resources that will help them to leave homelessness forever.  To support One Roof’s mission to equip and empower central Alabama to prevent and end homelessness through advocacy, education, and coordination of services, you can make a donation or contact One Roof by e-mail at info@oneroofonline.org.

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
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