Health Care for the Homeless in America
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Am Fam Physician. 2006 Oct 1;74(7):1099-1100.
In this issue of American Family Physician, Montauk1 provides an excellent summary on the obstacles many persons who are homeless face when seeking health care, as well as the guidelines that are available to physicians to help them care for this population. Finding adequate health care may not be the most important priority for displaced persons, who often are focused on just meeting basic needs. However, persons experiencing homelessness are among those most in need of medical care.
Mental illness and substance abuse are two major factors driving homelessness in the United States.2 Not surprisingly, persons without stable housing get sick more often and more seriously than their counterparts who have housing. One third to one half of the homeless population has chronic illnesses, compared with less than one fourth of the housed population.3 Mortality rates are three times higher among persons without homes than among housed persons of the same age.4 As a result of these factors, persons who are homeless have higher rates of hospitalization and emergency department use than the general population.5
To provide a multidisciplinary approach to health care delivery for the homeless, the Stewart B. McKinney Homeless Assistance Act was enacted in 1987. This legislation provided funding for education, emergency food and shelter, and transitional and permanent housing. With part of the funding, Health Care for the Homeless (HCH) organizations were established nationally. The program combines aggressive community outreach with integrated systems of case management, client advocacy, primary care, mental health, and substance abuse services.6
Currently, there are 186 HCH grantees across 50 states, the District of Columbia, and the Commonwealth of Puerto Rico. In 2006, Congress appropriated $156 million to support HCH programs. In 2005, 176 HCH grantees served more than 650,000 men, women, and children. Thirty-nine percent of service recipients were black, 36 percent were white, and 22 percent were Hispanic or Latino; 71 percent had no medical insurance, and 92 percent were living at or below the federal poverty level.7
Providing medical services for the homeless population is challenging. The HCH Clinicians’ Network (http://www.nhchc.org) is the nation’s leading organization that connects hands-on health care workers from many disciplines caring for persons who are homeless.8 The network has published eight sets of adapted clinical practice guidelines to assist physicians in providing optimal care for those who are struggling with homelessness. These recommended practice adaptations are discussed in Dr. Montauk’s article.1
Family physicians can make a positive difference in the lives of persons who are homeless or at risk of homelessness. To get involved locally, visit the HCH Information Resource Center (http://www.bphc.hrsa.gov/hchirc/directory) for information about programs in your community. Although all HCH programs hire their own physicians, some may be looking for volunteer physicians for their health centers, shelters, and soup kitchens, or for their mobile health care vehicles. Some programs also have developed a list of physicians who will accept patients in their own practices. I encourage your interest and participation in this extremely rewarding work.
BECHARA CHOUCAIR, M.D., is medical director of Heartland Health Outreach, Inc., in Chicago, Ill.
Address correspondence to Bechara Choucair, M.D., Heartland Health Outreach, Inc., 1015 W. Lawrence Ave., 2nd floor, Chicago, IL 60640 (e-mail: firstname.lastname@example.org). Reprints are not available from the author.
1. Montauk SL. The homeless in America: adapting your practice. Am Fam Physician. 2006;74:1132–8.
2. United States Conference of Mayors – Sodexho, Inc. Hunger and homelessness survey. A status report on hunger and homelessness in America’s cities. A 24-city survey, December 2005. Accessed September 1, 2006, at: http://www.usmayors.org/uscm/hungersurvey/2005/HH2005FINAL.pdf.
3. Zerger S. A preliminary review of literature. Chronic medical illness and homeless individuals. Nashville, Tenn.: National Health Care for the Homeless Council, Inc., 2002. Accessed September 1, 2006, at: http://www.nhchc.org/Publications/literaturereview_chronicillness.pdf.
4. O’Connell JJ. Premature mortality in homeless populations: a review of the literature. Nashville, Tenn.:National Health Care for the Homeless Council, Inc., 2005. Accessed September 1, 2006, at: http://www.nhchc.org/PrematureMortalityFinal.pdf.
5. O’Connell JJ. Utilization & costs of medical services by homeless persons: a review of the literature & implications for the future. Nashville, Tenn.: National Health Care for the Homeless Council, Inc., 1999. Accessed September 1, 2006, at: http://www.nhchc.org/Publications/utilization.html.
6. Bureau of Primary Health Care. Health Care for the Homeless Information Resource Center. The comprehensive response. Accessed September 1, 2006, at: http://bphc.hrsa.gov/hchirc/about/comp_response.htm.
7. Bureau of Primary Health Care, Health Resources and Services Administration. Uniform Data System (UDS) National Summary for 2005. Accessed September 5, 2006, at: http://bphc.hrsa.gov/uds/. (E-mail request required.)
8. National Health Care for the Homeless Council. Health care for the homeless clinicians’ network. Accessed September 1, 2006, at: http://www.nhchc.org/network.html.
Copyright © 2006 by the American Academy of Family Physicians.
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