March 29, 2006

By JULIE CHINITZ
Contributing Writer

Health care is often a do-it-yourself enterprise for people living on the streets of Yakima, just over the Cascade Mountains from Seattle. Steve Gaulke, homeless outreach case manager with Central Washington Comprehensive Mental Health, sees evidence of that enterprise every day.

“ They’ll do stitching of their own stitches,” he says. “They’ll live with broken ribs without going to the doctor.” To handle the pain of an inflamed tooth, he explains, “You either just take a lot of aspirin you bum from somebody, or street stuff to kill the pain, and if it gets so bad you ask somebody to knock it out of your mouth or take a pair of pliers and get it out.”

Going without adequate housing takes a heavy toll on the body, whether in the form of stress, increased exposure to the elements and infection, inadequate diet, or lack of a place to rest, recover, or properly store medications. Homelessness also leaves people vulnerable to assault. In Yakima, there have been reports of groups of thugs targeting homeless people, beating them with rocks and boards.

“ Homelessness is a direct cause of many diseases and health problems,” says Anita Monoian, CEO of Yakima Neighborhood Health Services (YNHS).

On March 1, Monoian’s organization celebrated the opening of Neighborhood Connections, a clinic dedicated to Yakima County’s homeless community. There, people living on Yakima’s streets can receive medical and dental care at no cost, and the dentist’s chair has been occupied since the clinic opened its doors.

With seven to 10 patients a day, Family Nurse Practitioner David Hibbs takes anywhere from a half an hour to an hour with each patient — time needed to help address immediate housing, mental health, and other needs that affect a patient’s ability to heal and recover.

Currently, Hibbs explains, “The biggest issues are urgent care, because they feel them. They’re painful.” But he hopes to develop continuing relationships with his patients so he can provide preventive care. YNHS is also working to establish a network of specialty care providers.

In addition to medical and dental care, Neighborhood Connections helps patients obtain health coverage and income support, such as food stamps and disability benefits, and connects patients to chemical dependency and mental health services. To cover the cost of premiums for Basic Health, the state’s sliding-scale health coverage program, the clinic is providing sponsorship for numerous patients who otherwise could not afford to enroll.

Meanwhile, outreach workers Dianne Trevino and Annette Rodriguez visit shelters, encampments, and social service agencies to spread the word and develop the trust needed to bring health care to people who have gone without. As Steve Gaulke explains, after years of being shut out of the health care system, people living on the streets need to believe that the offer represents more than an empty promise. “That’s been one failure we’ve had in the system: lack of follow-through,” he says.

One patient, Mark Shotgunn, was thrilled when he heard about the clinic, commenting, “It’s not often you get help like that.” He points out that being able to drop in at any time for medical care rather than having to schedule an appointment in advance is a big advantage. Soon he plans on coming in for a dental visit.

Neighborhood Connections’ ability to continue serving patients like Shotgunn depends on the state and federal governments’ funding of health insurance programs and community clinics.

In its first year, sixty percent of Neighborhood Connections’ funds will come from the federal government’s Health Care for the Homeless program, while YNHS must bring in the rest through reimbursement from Medicaid, Basic Health, or other sources.

Despite the need for greater investment in health, the federal government is rapidly dismantling coverage for low-income people. President Bush has proposed continued — although not necessarily adequate — funding for community health centers, including Health Care for the Homeless. Yet at the same time, Congress has passed major cuts to Medicaid, which provides insurance to many low- and moderate-income people.

In addition to letting states offer less than comprehensive coverage and introduce hefty costs for Medicaid enrollees, the federal government is creating new documentation requirements. To qualify, many applicants will have to have a U.S. passport or birth certificate — a big burden on homeless people. On top of these cuts, the Bush Administration is proposing even further defunding.

“ Many, if not most, of the community health centers depend on a significant portion of their clients having insurance,” says Patricia Post, policy analyst with the National Health Care for the Homeless Council. “Undermining programs like Medicaid has extremely severe implications for low-income people, including the homeless.” n

Julie Chinitz is a researcher for the Northwest Federation of Community Organizations. This is the first in an occasional piece on public health in Yakima County.