Help for homeless elusive and costly

January 21, 1998|By Lauren Siegel and Jeff Singer

ROBERT IS not blessed with good health. At 35, he is obese and beset by bronchial asthma, diabetes, high blood pressure, heart disease and hernias. Periodically, he's sent to state mental hospitals for treatment of depression.

He is also homeless. You may have seen him roaming the streets downtown.

Robert is a significant expense for taxpayers, but that cost would be reduced if his basic needs were met.

Robert's plight offers important lessons about how ineffective government programs can be. His health care is covered by Medicaid, which hasn't worked well for him since he was assigned to a health maintenance organization this year as part of Maryland's effort to reduce costs.

No room for the needy

He's also struck out in attempts to find affordable housing. He's on a long waiting list for subsidized apartments for the disabled; homeless shelters that provide beds for the disabled have no openings.

Ten years ago, Baltimore had many more emergency shelters for homeless people, including the disabled, than it has today. Federal funding cuts have forced many such shelters to close. Meanwhile, national and local housing policies have retreated from serving the poorest people.

As federal money for the homeless has decreased in recent years, so have the options for people such as Robert. That's costing us all a great deal of money and causing them a great deal of pain.

One day last fall, Robert was brought to our Health Care for the Homeless clinic by ambulance from a local hospital emergency room. The only instructions were contained on a note pinned to his chair: ''Please return our wheelchair.''

Two doctors, a nurse and a social worker spent six hours with Robert that day. The diagnosis? A recent accident had cost him the use of his legs, but he could walk again with physical therapy.

Also, he needed shelter, food and medication.

When we couldn't find a shelter to house him, the clinic staff took up a collection to pay for a motel room. We left for the night thinking that at least he would spend the night indoors.

Unfortunately, Robert spent the night sleeping in his wheelchair on the street because the publicly funded van that transports disabled people never arrived to take him to the hotel. We found him parked at the clinic's door the next morning.

It took several weeks to get an appointment with a physical therapist, something that used to take a few days before Medicaid became a part of a managed care system.

Meanwhile, Robert was admitted to another hospital at more cost to the taxpayer. Finally, he was sent to a rehabilitation center by the HMO.

During his 10-day stay there, Robert learned to walk with the help of a cane. But upon release, he had nowhere to go.

We sent him to a motel, where he was robbed and reinjured; subsequently, he was treated at three emergency rooms and in our clinic before being admitted to a hospital for hernia repair -- an injury suffered in the robbery.

Robert's case reinforces what we see every day: Homelessness is a health hazard that produces significant costs, which we all pay. When homeless, Robert's heart rate goes up, his mental health deteriorates, his blood pressure increases and to the emergency room he goes.

HMOs, which typically haven't served poor and homeless people, don't usually view health care in a comprehensive fashion, including the need to address social and environmental needs of patients. If HMOs treat vulnerable folks like they treat their other customers, they fail to serve poor people and the public interest.

Permanent housing would likely prevent many of Robert's costly hospital admissions and emergency room visits. If he had a fixed address, the costly 10-day stint at the rehabilitation hospital wouldn't have been necessary; a physical therapist could have treated him at home.

As for housing, the Housing Authority of Baltimore City is reducing the density of poverty in its developments by replacing high-rise housing developments with much smaller townhouse communities. The housing authority has reduced the number of poor people it serves, leaving people such as Robert in limbo.

But adequate housing is absolutely essential to good health. Giving the poor access to health care and housing requires a level of commitment by private and public officials that does not come cheaply.

But then again, neither do seven hospital visits in six weeks.

Lauren Siegel and Jeff Singer are staff members of Health Care for the Homeless, a 12-year-old clinic that treated 15,000 homeless people last year.

Pub Date: 1/21/98

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