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The Barriers for Those Experiencing Homelessness to Receive Proper Health Care

Complications with health conditions can be the cause of an individual experiencing homelessness. They may lose employment because of an injury or illness and then go through their savings, attempting to keep up with their bills until they lose their home. Once they experience homelessness, they face many barriers to receiving proper health care. 

Individuals experiencing homelessness endure physical, mental, and social hardships that increase their mortality rate. According to the National Health Care for the Homeless Council, those experiencing homelessness die around 12 years sooner than the general population of the United States. Harsh living environments, trauma, extreme poverty, and barriers to receiving health care lead to their unstable health. Healthcare inequality for those experiencing homelessness has only been made worse by the pandemic because they have a higher risk of catching COVID-19. Common illnesses or injuries that are not cared for can easily intensify until the only option is to go to the emergency room and be hospitalized for care. Small things like cuts and a common cold can develop into less manageable issues like an infection or pneumonia. People experiencing shelter instability usually do not have access to showers or baths, leading to poor hygiene and exasperated injuries and illness. Experiencing homelessness can make chronic issues difficult to control; for example, managing diabetes can become almost impossible when certain foods or medications are out of budget or syringes are not allowed in shelters. Keeping a healthy diet can be challenging for those relying on soup kitchens, where meals are usually high in salts, sugars, and starches, which makes for a filling, but not a nutritious meal. The risks to the  health of those experiencing homelessness are already daunting.

Both mental illness and substance abuse are common among those experiencing homelessness because they live through tough circumstances. Medications to aid withdrawal or manage mental illness can be hard to come by, leading to substance abuse. Emotional and mental stressors have a great effect on those suffering from homelessness. Most have gone through a lot of trauma in their lifetime, and specific needs should be met for those with mental illness and those who suffer from substance abuse to help them overcome their issues. 

General barriers to health care that individuals who suffer from homelessness face are difficulty in scheduling appointments, lack of transportation, lack of health insurance, and cost. Appointments can be hard to make in a shelter or on the street, and transportation to make those appointments can be burdensome. In the article, “Disparities in Health Care for the Homeless,” Alexandria Lee states, “shamefully, in the United States, there are still over 40 million cities without health insurance.” Health insurance is complicated for those experiencing homelessness to receive. Food and shelter are usually priorities when it comes to spending, and there is not enough money to treat medical conditions. 

Social barriers also play a role; those enduring homelessness may mistrust the healthcare system because of previous discrimination. They might be afraid to get help because they are uninsured or believe themselves undesirable. Even if they  receive medical treatment, those experiencing homelessness are less likely to receive a life-saving diagnosis or beneficial procedure in the United States than housed individuals. People experiencing homelessness are often discharged with scarce resources and back out in the elements, where it is almost impossible to recover, leading to high readmission rates and negative health outcomes. This situation is called “patient dumping,” which was addressed in California’s Senate Bill 1152 in 2018. The article “Dying in the shadows: the challenge of providing health care for homeless people,” by James J. O’Connel states, “this legislation requires that hospitals provide a meal, transportation, and clothing to homeless patients as well as documentation of discharge to a safe location.” Although this legislation seems helpful, it does not solve the fundamental problem of lack of health care and a safe place to recover for those experiencing homelessness who are discharged from the hospital. 

Providing affordable housing and health care is the clearest solution to the issue. Those still experiencing shelter instability can be aided by physicians willing to deliver care directly to them so their health care needs can be met. This can be done through outreach and community services. Alexandria Lee explained that “care programs in cities such as Boston, Chicago and Washington that have attempted to compensate for the lack of safe housing by providing 24-hour short-term medical care for people ready for discharge from hospital, but too ill and vulnerable to return to the streets.” Now, over 30 cities in the United States and Canada are attempting similar models to aid those experiencing homelessness with health problems. Ultimately, housing and health care help prevent and end the suffering and health ailments of those experiencing homelessness. 

Sources:

https://nhchc.org/wp-content/uploads/2019/08/homelessness-and-health.pdf

https://ihpl.llu.edu/blog/disparities-health-care-homeless

https://www.cmaj.ca/content/cmaj/170/8/1251.full.pdf

https://www.nature.com/articles/s41572-020-00241-2.pdf

https://www.ncbi.nlm.nih.gov/books/NBK235884/

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