Seriously Ill and Homeless in New York: A Problem We Need to Solve
Mayor de Blasio has made affordable housing the cornerstone issue of his administration. This includes strategies to address the alarming rise in homelessness, which according to the Coalition for the Homeless, has reached its highest levels since the Great Depression.
In the Mayor’s recent State of the City address he pledged to end veteran homelessness by the end of 2015. His sweeping “Housing New York” plan spells out steps to help working families, domestic violence victims, seniors and those with mental health and substance abuse issues avoid homelessness altogether, or transition more quickly out of the city’s shelter system and into permanent housing.
These are laudable goals, but there is one homeless population that is falling through the cracks: chronically or acutely ill people who do not need to be in the hospital but cannot receive or access the medical care they require within the shelter system. It’s time New York did more to make sure these highly vulnerable individuals get the attention they deserve.
I am part of Collaborative Housing and Health (CHH), a working group of medical and legal professionals who are exploring ways to address the pressing needs of homeless patients in New York City. Our group includes attorneys from NYLAG and New York Lawyers for the Public Interest, clinicians, researchers and managers from Memorial Sloan Kettering Cancer Center and Montefiore Medical Center, and a representative from the Susan G. Komen New York City Affiliate.
CHH is part of a national movement among health professionals to build awareness for the grim reality that housing and other Social Determinants of Health including employment status, income, education, and access to food, can dramatically impact a person’s health and her use of medical services and resources.
“The availability of medical care alone is not enough to achieve optimal health for acute or chronically ill people who are homeless or living in substandard housing,” said Dr. Francesca Gany, Chief of the Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering. “Our own studies have shown, for instance, that unstable or overcrowded housing conditions were a significant predictor of missed cancer treatment appointments.”
Medical Respite Programs Make Sense.
To combat this problem, cities across the country have established medical respite programs designed to address the unique needs of homeless patients struggling with cancer, diabetes, or other debilitating conditions who require ongoing treatment, medical equipment such as an oxygen tank, or access to a kitchen to accommodate dietary restrictions.
These services have improved lives and lowered costs to the health care system at a time when hospitals are under mounting pressure to reduce or shorten costly hospital stays. Patients who would otherwise have been forced to remain hospitalized receive medical care, medications, and nutritious meals, as well as assistance in accessing outside medical services such as chemotherapy and radiation. Patients no longer need to make repeated trips to the Emergency Room, often returning sicker each time as their health deteriorates.
One size does not fit all.
We will need a range of respite services to meet the needs of a city of 8.4 million and a homeless population of over 60,000. Some patients require a medical respite program with on-site medical staff, but others may simply need a shelter with accommodations to address their health issues. (A number of such programs can be found on the website of the National Health Care for the Homeless Council.) Here are two examples:
- In New York City, Communilife provides safe, transitional housing for people with cancer and other non-chemically dependent patients who are medically cleared and do not require hospitalization, but cannot be discharged because they are homeless. Communilife receives referrals from two hospital systems in the Bronx: Montefiore Medical Center and Bronx Lebanon Hospital Center. The program aims to reduce the hospitals’ financial burden by providing temporary residential care that enables patients to be discharged to a safe environment where they can access medical care and other supportive services. The program also helps patients transition to permanent housing while continuing to receive medical care. While Communilife does incredible work, they have only ten beds and cannot begin to meet the overwhelming need.
- In New Haven, Columbus House, a homeless shelter, is piloting a respite program designed to lower state Medicaid costs related to unnecessary hospitalizations for the homeless. Referrals come directly from Yale New Haven Medical Hospital and participants are linked immediately to visiting nurse services. The 12-bed program includes 24-hour supervision, referrals to health care providers, transportation and case management services.
Break the Cycle.
Beyond improved health outcomes, medical respite services can also break the cycle of homelessness. While patients are protected and secure, case managers can help to identify appropriate long term housing options. Through medical-legal partnerships, clinicians can refer patients to an attorney, who can help to secure public housing, and public benefits such as Social Security and food stamps, stabilizing patients’ economic situations and further optimizing their health and wellbeing.
In the months ahead our CHH members plan to meet regularly as we develop more concrete recommendations for how New York City can best address the unique health care and housing needs of this population. We are still in the research and planning phase, but have every hope that New York will embrace the medical respite model as we attack the housing crisis in our midst, and fulfill the mayor’s vision of a city where everyone has a safe and decent home.