Limited Access to Healthcare in Homeless People

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                                         (Photo credit: Metta Fund)

Homelessness has been a complex and ubiquitous challenge with a variety of underlying socioeconomic factors in recent years. According to the 2023 analysis of homelessness by the U.S. Department of Housing and Urban Development, the United States had 653,104 homeless people counted on a single night in 2023- a 12% increase from 2022. Portland, Oregon is among those cities with the rapid increase in homelessness, rising by 65% from 2015 to 2023.  With its complex nature and rapid growth, the limited access to healthcare in homeless populations is one of the associated problems that need to be addressed more appropriately. 

Homeless people are more susceptible to diseases that are attributable to their living conditions, including exposure to communicable diseases, opioid or illicit drug use, harmful weather conditions, violence, and malnutrition. In an advisory of Substance Abuse and Mental Health Services Administration, people experiencing homelessness have a higher rate of chronic health conditions, mental illness, and substance use disorders than people who are stably housed. Especially, opioid and drug use are currently rampant among the homeless population in Portland. Some studies show that those individuals with homes typically live 30 years more than homeless people. The limited access to healthcare services would contribute to the increased likelihood of adverse health outcomes, resulting in even a shorter life expectancy. 

In the United States, healthcare would be extremely costly if the individual was uninsured or only had partial health coverage. Some homeless people are insured under Medicare and Medicaid, but many do not have insurance. They thus do not have access to an annual checkup which leads to delayed health conditions. The only time that they can have these conditions diagnosed or treated is when they present to the emergency department. However, those visits to emergency departments are inadequate as homeless people are often discharged without resources for complete recovery. Their living conditions also exacerbate the worsening health conditions, leading to higher rates of rehospitalization. The urgent needs for food and shelter and the lack of reliable transportation also contributes to adverse health outcomes. 

Homelessness is a serious public health issue. And, the best course of action should be carried out to put an end to this crisis. Homelessness is multidimensional and not only confined to housing instability. Healthcare access is another important associated problem that needs to be addressed. More outreach programs that seek out homeless people on the streets, such as mobile vans, street team medicine, and shelter-based clinics need to be funded. With empathy and a holistic approach, those outreach programs can build trust and provide high quality and comprehensive outpatient care for this vulnerable population. Specialty care also needs to be provided as Medicaid and Medicare do not cover those cares which include complex behavioral services, vision, and dental care. 

We can contribute to reducing and preventing homelessness at an individual level by being involved in outreach programs as either an employee or a volunteer. Those programs are always in constant need of volunteers to help them with providing better care to the homeless population. Specifically, Portlanders can volunteer at Portland Street Medicine, and Portland Rescue Mission as well as shelters and addiction treatment centers in Multnomah County. We need to take action immediately if we care about our people and our country and want to stop this homelessness crisis. 

If you're interested in learning more about this public health issue and would like to get involved, here are some resources:

Baggett, T. P., O'Connell, J. J., Singer, D. E., & Rigotti, N. A. (2010). The Unmet Health Care Needs 
        of Homeless Adults: A National Study. American Journal of Public Health, 100(7), 1326-1333. 
        https://doi.org/10.2015/ajph.2009.180109

Bedmar, M. A., Bennasar-Veny, M., Artigas-Lelong, B., Salva-Mut, F., Pou, J., Capitan-Moyano, L., 
        Garcia-Toro, M., & Yanez, A. M. (2022). Health and access to healthcare in homeless people: 
        Protocol for a mixed-methods study. Medicine, 101(7), e28816. 
        https://doi.org/10.1097/MD.0000000000028816

Healthcare and Medical Resources for the Homeless. (2020, March 10). Western Governors 
        University. https://www.wgu.edu/blog/healthcare-medical-resources-homeless2003.html

Jain, S. H. (2021, April 17). Homelessness Is A Healthcare Issue. Why Don't We Treat It As 
        One? Forbes. https://www. forbes.com/sites/sachinjain/2021/04/17/homelessness-is-a-
        healthcare-issue-why-dont-we-treat-it-as-one/?sh=4ccb43f477e3

NAEH. (2023, December 15). HUD Releases 2023 AHAR Data: 12 Key Data Points to Understand 
        the Current State of Homelessness in America. National Alliance to End Homelessness. 
        https://endhomlessness.org/blog/hud-release-2023-ahar-data-12-key-data-points-to-understand-
        the-current-state-of-homelessness-in-
        america/#:~:text=Understanding%20the%20Severity%20of%20the

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