---------- Forwarded message ----------
Date: Thu, 27 Mar 1997 18:39:52 -0800

Subject: Healthcare for the Homeless

>>         NCH Fact Sheet #12
>>         Published by the National Coalition for the Homeless, March 1997

>>         Poor health is closely associated with homelessness. For families
>>         struggling to pay the rent, a serious illness or disability can
>>         start a downward spiral into homelessness, beginning with a lost
>>job,
>>         depletion of savings to pay for care, and eventual eviction.
>>Thir{*filter*}
>>         percent of homeless patients surveyed in a national study
>>published in
>>         the 1980s stated that poor physical health was a factor in their
>>         becoming homeless. Of those patients, half said health was a "major
>>         factor" and 15% stated that it was the "single most important"
>>factor
>>         (Wright and Weber, 1987). The problem has become much worse in
>>         the last decade.

>>         The rates of both chronic and acute health problems are extremely
>>         high among the homeless population. With the exception of obesity,
>>         strokes, and cancer, homeless people are far more likely to suffer
>>         from every category of chronic health problem. Conditions which
>>require
>>         regular, uninterrupted treatment, such as tuberculosis, are
>>extremely
>>         difficult to treat or control among those without adequate shelter.

>>         Many homeless people have multiple health problems. For example,
>>         frostbite, leg ulcers and upper respiratory infections are
>>         frequent, often the direct result of homelessness. Homeless people
>>         are also at greater risk of trauma resulting from muggings,
>>beatings,
>>         and{*filter*}.  Homelessness precludes good nutrition, good personal
>>hygiene,
>>         and basic first aid, adding to the complex health needs of
>>homeless people.
>>         In addition, some homeless people suffering from mental illness may
>>         use {*filter*} or {*filter*} to self-medicate, and those with {*filter*}ion
>>         disorders are also often at risk of HIV and other communicable
>>         diseases.

>>         PROGRAM AND POLICY ISSUES

>>         People who are homeless are overwhelmingly uninsured and often
>>         lack access to the most basic health care services for their complex
>>         health care needs. At present, there is one federally funded
>>program,
>>         Health Care for the Homeless (HCH), that is designed specifically to
>>         provide health care to homeless persons.. Recent evaluations of the
>>         HCH programs have found that HCH projects provide primary health
>>         care in a cost-effective and efficient manner (Cousineau, 1995). HCH
>>         projects are successful because they are designed and controlled by
>>         local communities to fill significant gaps in existing health care
>>         delivery systems. Health and social service workers in HCH
>>projects provide
>>         comprehensive care in accessible clinics. No other indigent care
>>         system provides this service. In Fiscal Year 1995, the HCH program
>>         awarded grants to 123 community-based organizations who, in turn,
>>         expanded their service network through arrangements with over 300
>>         service contractors. As a result, the HCH program serves more than
>>         450,000 clients in 48 states, the District of Columbia and
>>Puerto Rico.
>>         For the people served by Health Care for the Homeless programs, the
>>         restoration of physical health is often a first step toward
>>reentry into
>>         stable housing and mainstream society.

>>         However, the crumbling indigent care network, the development of
>>         managed care, and the increase in homelessness have made it
>>         impossible for HCH programs to reach the majority of homeless
>>         people in America. Of course, housing is the first form of treatment
>>         for homeless people with medical problems, preventing many illnesses
>>         and making it possible for those who remain ill to recover.
>>Healthcare
>>         reform to provide greater access to affordable services is also
>>essential
>>         in the fight to end homelessness. A good health care reform plan
>>could
>>         reduce homelessness and, more significantly, help to prevent future
>>         episodes of homelessness, as well as ease the pain -- and even
>>prevent
>>         unnecessary deaths -- of those on the streets. A reformed health
>>care
>>         system could also reduce the impact and cost of communicable
>>         diseases and other illnesses.

>>         Establishing health care as a right would correct a fundamental
>>social
>>         problem. It is imperative that health care reform be based upon
>>three
>>         basic principles: 1) universal coverage by a date certain; 2)
>>guaranteed
>>         access to the health care delivery system; and 3) comprehensive
>>         benefits.

>>         RESOURCES

>>         Bricker, Philip et al. Under the Safety Net: The Health and Social
>>         Welfare of the Homeless in the United States, 1991. Available as
>>         bookstore order ISBN (paper) 0-393 30875-8 for $14.95, or (with
>>         S&H added) from W.W. Norton and Company, 500 Fifth Ave., New
>>         York, NY 10110; 212/354-5500.

>>         Cousineau, Michael et al. A Study of the Health Care for the
>>         Homeless Program: Final Report, 1995. Available, free, from the
>>         National Clearinghouse for Primary Care Information, 2070 Chain
>>         Bridge Rd., Suite 450, Vienna, VA 22182-2536; 800/400-2742. In the
>>         Washington, DC metro area: 703/902-1248.

>>         Gage, Larry S. et al. America's Urban Health Safety Net, 1994.
>>         Available for $20.00 from National Association of Public Hospitals,
>>         1212 New York Ave., NW, Suite 800, Washington, DC 20005-6148;
>>         202/408-0223.

>>         Moran, William and Natalie Coen. Medicaid and Homeless
>>         Individuals, 1992. Available, free, from OEI, Office of Inspector
>>         General, U.S. Department of Health and Human Services, Region V,
>>         105 W. Adams St., 23rd Floor, Chicago, IL 60603; 312/353-4124.

>>         National Coalition for the Homeless and the National Health Care for
>>         the Homeless Council. Life and Death on the Streets: Health Care
>>         Reform and Homelessness, 1993. Available for $5.00 from the
>>         National Coalition for the Homeless, 1612 K St., NW, Suite 1004,
>>         Washington, DC 20006-2802; 202/775-1322.

>>         National Coalition for the Homeless. Mourning in America: Health
>>         Problems, Mortality and Homelessness, 1991. Available for $5.00
>>         from the National Coalition for the Homeless, 1612 K St., NW, Suite
>>         1004, Washington, DC 20006-2802; 202/775-1322.

>>         National Coalition for the Homeless and the National Health Care for
>>         the Homeless Council. 'Tis a Gift to be Simple: Homelessness,
>>         Health Care Reform, and the Single Payer Solution, 1994.
>>         Available for $5.00 from the National Coalition for the Homeless,
>>         1612 K St., NW, Suite 1004, Washington, DC 20006-2802;
>>         202/775-1322.

>>         National Health Care for the Homeless Council, Inc. Combatting
>>         Tuberculosis and Homelessness: Recommendations for Policy
>>         and Practice, 1994. Available for $5.00 from the National Health
>>         Care for the Homeless Council, P.O. Box 68019, Nashville, TN
>>         37206 8019; 615/226-2292.

>>         Wright, James and Eleanor Weber. Homelessness and Health, 1987.
>>         Out of Print. McGraw Hill, 1221 Avenue of the Americas, New York,
>>         NY 10020; 212/512-2000.

>>         ADDITIONAL RESOURCES

>>         Health Care for the Homeless Information Resource Center, c/o
>>         Policy Research Associates, 262 Delaware Avenue, Delmar, NY

>>         The Health Care for the Homeless Information Resource Center
>>         publishes free annotated bibliographies and other information on
>>many
>>         aspects of health care and homelessness (tuberculosis, HIV/AIDS,
>>         dental needs, child development, etc.).

>>                                       ***

>>         National Health Care for the Homeless Council, P.O. Box 68019,
>>         Nashville, TN 37206 8019; 615/226-2292.

>>         The National Health Care for the Homeless Council advocates on
>>         federal health care policy issues, coordinates the staffing of
>>an HCH
>>         clinicians network, and provides support to local projects.

>>                                       ***

>>         National Resource Center on Homelessness and Mental Illness, c/o
>>         Policy Research Associates, 262 Delaware Avenue, Delmar, NY

>>         The National Resource Center on Homelessness and Mental Illness
>>         maintains and updates a bibliographic database on homelessness and
>>         mental illness. The Center publishes a series of free, annotated
>>         bibliographies and an information packet on financing.

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