Real Change News | Long-term stress causes health problems

July 21, 2010
Vol: 17 No: 29

News

Long-term stress causes health problems

by: Sara N. Reardon , Guest Writer

Medical care for homeless an ongoing challenge, says report

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How will the new health care reform bill cover the needs of homeless people? This and other issues were discussed at a meeting July 15 at the King County Courthouse.

The King County Board of Health received annual updates from the Health Care for the Homeless Network and the Tobacco Ad Hoc Committee. The HCHN provides care for the homeless population of King County through contracts with local agencies such as health centers and shelters; serving 21,906 patients in 2009.

In her presentation to the board, HCHN program manager Natalie Lente said that the aim of the program is to provide services “where people are,” such as shelters, streets and public centers at 43 locations. “We want to provide support for the patient from street to primary care to permanent housing,” said Lente.

Among the greatest challenges facing homeless patients is when hospitals discharge them into the streets before they have fully recovered. HCHN provides transitional housing in these instances: women are housed at the YWCA and men at the Salvation Army. Additionally, HCHN partners with the Respite program to provide beds for patients who are too ill to stay on the street but not ill enough for hospitalization.
Of the patients HCHN serves, 49 percent have no health insurance. The new health care reform bill will cover the homeless population, said Lente, “but the complexity of their needs and the barriers they face make it very difficult for them to access that coverage.” Because of this, HCHN “works to get people enrolled in appropriate, sensitive care,” she added.

The way to provide the most effective care, said planning council co-chair Greg Francis, is to ensure that “consumer voices are heard” in decision-making. Formerly homeless himself, Francis cited his own experiences of living in shelters and “seeing other people who were around me who have multiple health problems” but were unable to access the specialized care they required.

One example was the ability to have a psychiatrist as both therapist and prescriber, which Francis said was a “very important thing” to mental health patients. According to the report, about half of HCHN patients have disorders stemming from mental illness or substance abuse.

Planning council co-chair Maureen Brown, a physician at Swedish Medical Center, outlined five specific health problems that HCHN targeted in 2009, including cancer screening, low birth weight of newborn babies and childhood immunizations.

Prenatal and perinatal care remain challenges for the homeless because chronic stress is a cause of low birth weight. “Small babies are at higher risk to develop hypertension, diabetes, and have small babies themselves,” said Brown. But compared to national averages, King County was significantly ahead, with 77 percent of 2-year-old homeless children being up to date on their immunizations.

The final two areas of focus in 2009 were diabetes and hypertension. “These are going to continue to be a challenge,” said Brown, since they are difficult to treat under the best conditions, and are far more complex than just taking a drug. Patients being treated with insulin, for example, need reliable access to food, a provider, and “an environment that promotes health.”

“Housing is a health issue,” said Francis, adding that health organizations partnering with housing providers is “the only way success is going to be achieved.”

In addition to the HCHN presentation, the Tobacco Ad Hoc Committee, which works to improve tobacco policies in King County, presented its own progress report to the Board. Program manager Scott Neal reported on the committee’s current projects, which include enhancements to the public smoking ban, clarifying smoking policies in public housing, and restricting the sale of flavored tobacco products that can be marketed toward youth.

The entire HCHN report can be downloaded from www.kingcounty.gov/healthservices/health/personal/hchn.aspx

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