originally published pre-COVID
Healthcare and Homeless Problem
We have a healthcare problem and a homeless problem. Our community sees the homeless crisis unfolding and we want action. We want to provide help in order to get folks off the street. One form of help that’s often overlooked is basic healthcare needs.
Many of the physiological needs of the homeless population are already missing. Safety needs, which include personal, emotional, financial security and health and well-being are also missing.
Without these needs being met how do we move thousands of people off the streets?
Dr. Jen Hartmark-Hill is a Mayo Clinic trained Family Medicine Physician. She works as faculty at the University of Arizona College of Medicine-Phoenix and is the Medical Director for S.H.O.W. Community Health Initiative and Street Medicine Phoenix.
She is an avid advocate for patients and for health care policies that address the social determinants of health. She sat down and answered some of your questions regarding Healthcare and our homeless population.
Where do homeless individuals get healthcare?
The Phoenix VA provides many high quality and comprehensive services to veterans. Circle the City, which includes Parsons Family Medicine Clinics, is really excellent for integrated care and services, as are St. Vincent de Paul, Native Health, Wesley Clinic, Mountain Park, Adelante clinics, Dignity/St. Joe’s and the Honor Health Neighborhood Outreach Access to Healthcare (NOAH) clinics.
Most of these clinics have medical, mental health, dental care and staff who can help patients get insurance through AHCCCS (Medicaid).
For a variety of reasons, though, a lot of people we see don’t or are unable to seek out care on their own, and so Street Medicine Phoenix has a really vital role in connecting people to care and resources.
What is Homelessness?
Homelessness has been defined as a lack of stable housing.
This includes when a person has to stay with a friend or relative temporarily because they can’t afford housing or they are discharged from a hospital or incarceration without a stable place to go.
It also includes people who are living in their cars, in shelters and in unsheltered situations on the streets. Based on poverty levels, rising and unaffordable housing costs and many other factors, experts estimate that 1 in 8 Americans is at risk of becoming homeless during their lifetime.
Upwards of 30-40% of people experiencing homelessness in the US are families with children.
Another counter-stereotype statistic is that about 40% of people experiencing homelessness are employed.Dr. Jen Hartmark-Hill, Street Medicine Phoenix
They are working but can’t afford their rent or have had a record of unstable housing situations and can’t get approved.
Only about half of people experiencing homelessness are chronically homeless. The rest have experienced some adverse event and suddenly find themselves unable to pay their rent, eg. after the loss of a job, a bankruptcy situation related to chronic illness or other types of unexpected bills.
In your estimation, how many homeless people are in the City of Phoenix?
The Point-in-Time survey released this summer counted over 6,600 people in Maricopa County alone. It is especially alarming that more and more people are living in unsheltered situations—in the streets, in desert washes and other places not meant for habitation.
Five years ago, about 25% of homeless people were unsheltered, but now this has doubled to about 50%.Dr. Jen Hartmark-Hill, Street Medicine Phoenix
This leads to a huge burden of heat-related illnesses, injury, and death when temperatures soar well into the hundreds.
The number of homeless encampments is also on the rise, with last estimates at about 1,500. When you have people without amenities, clean water, and adequate nutrition, infectious diseases tend to break out as well. Trash and waste accumulate, and it is a strain on local businesses and neighborhood parks.
Lack of access to preventive services and health care lead to worsening progression of illness by the time people go to the Emergency Department.
This increases hospitalization, including intensive care admissions, with higher-cost care that is designed to be life-saving, but not to address or prevent underlying causes. This is better accomplished by primary care, mental health programs, and social services in the outpatient setting.
We really need impactful, long-term solutions from both government and private industry or things will continue to spiral.
How does your organization help the homeless?
In recognition of the escalating needs of our patients experiencing homelessness, healthcare faculty and students at all three state universities—Arizona State University, Northern Arizona University and The University of Arizona came together to create a clinic and community health initiative (Student Health Outreach for Wellness, S.H.O.W.) to provide care through interprofessional teams– physicians, nurses, physical therapists, occupational therapists, PAs, Speech Therapists, and pre-health profession undergrad students.
Our inclusive interprofessional model also includes law students and faculty from ASU, and we are looking to include veterinary students from Midwestern University to provide care to the pets of patients experiencing homelessness. We originally operated a clinic and ran health fairs on the Human Services Campus in downtown Phoenix. We’ve since expanded beyond this to other sites.
What is Street Medicine?
Additionally, we have integrated an outreach arm called, “Street Medicine Phoenix,” an entity started by two students from the University of Arizona College of Medicine-Phoenix, Justin Zeien, and Jeffery Hanna.
Many people are too ill or fearful to go to a clinic, so our Street Medicine teams help them where they are at—in the streets and at churches where they are being clothed and fed. We show them kindness and respect, endeavor to provide some dignity by supplying donated socks, hygiene kits, and water.
Street Medicine addresses acute medical concerns (such as diabetes and high blood pressure), mental health concerns, and very importantly, we connect them with services and support. We help them long before a medical emergency develops, thus relieving the costs of emergency department visits and calls to 9-1-1. We are currently also planning to collaborate with the County Health Department to help provide immunizations that can prevent or minimize infectious disease outbreaks.
In this way, we are working to provide both care to the individual and care that makes a difference for public health, our communities and the health system.
What’s the most common reason for being homeless?
It’s different for every person. Common denominators can include untreated mental health concerns, often because of lack of access or lack of support in navigating the complex mental health system. Addiction is another factor for some. Traumas and abuse during childhood predict increased risk of becoming homeless, as do veteran status and PTSD. Some people are fleeing domestic violence situations.
There aren’t enough shelter beds, and many people are fearful of staying in shelters because of experiencing violence or theft of belongings when staying in a shelter in the past.
Those who identify as LGBTQ+, especially teens, are at risk of becoming homeless after being kicked out of their home or bullied. The impact of racism on health and economic opportunities is another important factor.
We see a disproportionately large percentage of black males who are homeless compared to general population demographics, analogous to the criminal justice system.
Has your organization seen a shift or change locally in demographics in the past 10 years?
Overall, the numbers of people experiencing homelessness have been on the rise. This includes veterans and notably higher percentages of female veterans. The homelessness crisis in California, related to skyrocketing and completely unaffordable housing, has had a huge impact on us as well.
Our housing prices are on the rise, too, especially in the downtown area, as growth and gentrification are building momentum. We need to be doing more to protect the folks who are struggling as a result.
What can local government do to help improve your ability to provide better services??
We really need to focus on collaboration with Housing First groups to provide shelter. As the term, “housing first” suggests, this is just a first step. Once people have housing, then wrap-around social services and medical care must be provided, depending on unique individual needs.
Some may have lost their ID in the process of leaving unsafe situations like domestic violence. There are services to help with this. Before someone can start to put their life back together, they may need legal help. They may need help with health issues, such as mental health problems or addiction.
Qualifying for housing shouldn’t be dependent on someone fixing these things on their own. It isn’t a logical way forward, from a medical whole-person perspective, of what is evidence-based and what works.
One organization that has a very good model of how this can be done is United Healthcare Community Plan. They are currently developing their model in Phoenix and hoping to expand it to other cities across the US. The model is good, but it’s on a small scale at this point.
Healthcare and Homeless in the City
I admire the City of Phoenix “Phoenix Cares” program, and the shift toward a community policing model and decriminalization of being homeless. This has occurred under the strong leadership of Chief of Police Jeri Williams.
Instead of criminalizing someone who is suffering from homelessness, which further spirals them downward, she has empowered her officers to connect individuals with services and help. I hope to see more local government support of resources for individuals and families experiencing homelessness to help them rebuild their lives.
What do residents of Phoenix not know about Street Medicine Phoenix?
It’s understandable that for most people, it’s often tough to know how to best help people experiencing homelessness. I would say that it is not by giving money to panhandlers. Government officials and community organizations that do this work have started a Healthy Giving Council.
It is preferable to support organizations like S.H.O.W./Street Medicine Phoenix, Circle the City, Phoenix Rescue Mission, etc, with donations or volunteer time, in order to have a much greater impact and long-term effect.
One thing that people who encounter a homeless individual can do to help them is to call 2-1-1 or go to 211Arizona.org to find resources like transportation, housing and shelter, cooling stations, food, clothing and help with paying bills. There are also links to veterans’ services, employment services, mental health, substance use and hotlines for the Crisis Response network, child abuse, domestic violence, human trafficking and sexual assault.
It’s a one-stop shop for local resources, which is limited, but it’s a start. We give out 211Arizona cards to every person we engage during Street Medicine Phoenix outreaches. People can get free 211 cards to give out through a link on the website.
Other information to share is if someone can get to the Human Services Campus, there are a plethora of resources.
People start in the Brian Garcia welcome center where staff assess what is needed. They have the CASS shelter, Lodestar Center to help find employment, and ID project. Dental and medical services, food, clothing, legal help and much more.
Are there other homeless shelters or organizations that you collaborate with?
We want to collaborate and provide synergy, not just duplicate services.
One of the limiting factors we have is that we need physicians, pharmacists, social workers, nurses, OT/PT and other health professionals to volunteer with us so more students from those disciplines can volunteer in supervised roles.
We do collaborative events with Phoenix Rescue Mission, provide care at Grace Lutheran Church and will be going out when Church on the Streets has outreaches to provide medical care and resource referrals, to name a few.
As part of the credentialing process, health professionals qualify for adjunct faculty status with the University of Arizona College of Medicine-Phoenix (if they are physicians), ASU College of Nursing & Health Innovation (for nurses, DNPs), etc. This also provides free liability coverage for volunteer work through the Arizona Board of Regents.
It’s a great opportunity to teach the next generation of health professional students and build relationships with inter-professional colleagues. All while making a significant positive impact for our patients and community!
Here’s what’s on my mind:
Quality healthcare is not cheap. In my econ courses we always say that the wealthy in Arizona have quality healthcare. The poor in Arizona have incredible healthcare in AHCCCS (Medicaid). The lower middle class have it the worst.
We can’t get people off the streets if their basic needs aren’t being met. Organizations like Street Medicine help support the healthcare needs of homeless individuals that don’t or won’t go into a clinic or hospital setting.
Is anyone among you suffering? He should pray. Is anyone in good spirits? He should sing praise. Is anyone among you sick? He should summon the presbyters of the church, and they should pray over him and anoint [him] with oil in the name of the Lord, and the prayer of faith will save the sick person, and the Lord will raise him up. If he has committed any sins, he will be forgiven. James 5: 13-15
How do we get homeless off the street if they don’t have their basic healthcare and security needs met?