Homelessness is a serious problem in USA. There are approximately 650,000 people experiencing homelessness every night and every year more than 1.6 million Americans has to sleep in shelters or transitional housing for at least one night (Hwang, Stephen W, et al.). As appeared in Wikipedia, about 12,500 homeless people sleep on the streets or in shelters in Seattle King County Area. These people are considered medically vulnerable that the expected life length is only 41 to 47 years, which is about half the national average age — 78.(Barriers)
At the same time, the rate of deaths of homeless is rising rapidly. 53 homeless person died in New Orlean in 2016, but in 2017, the number became 60, which was a 13 percent jump than the previous year. In New York, homeless deaths also jumped 30 percent in 2017 in comparison to 2016. Moreover, in King County, Washington, the deaths found in abandoned homes and cars, under elevated highways, in motels, shelters and hospitals nearly doubled in three years (Richard A. Webster). In fact some of the deaths can be avoided if we are able to find some proper and effective solutions to help this suffering homeless population.
These deaths have many reasons. A majority of homeless people have substance use and mental health problem, which would definitely be fatal after years or even decades without treatment. However, even if some addicted homeless want to get rid of the substances, it is always not easy to get help. According to the article “‘Our streets are our mental wards’: New Orleans homeless deaths are rising,” impatient beds are in shortage and we don’t have enough resources for the indigenous. “In a city that historically has high rates of alcohol and drug abuse, however, there are only 18 inpatient beds – provided by the non-profit Odyssey House – for indigent people in need of medically-supervised detoxification. Withdrawing from alcohol or heroin can often be life-threatening, which is why addicts looking to get clean need to be placed under the care of doctors and nurses.” (Richard A. Webster and Katherine Sayre) In this article, Dr.Peter DeBlieux, who is a chief medical officer said, there were only three times that they have been able to offer free impatient beds to people in emergency department during the three years since the University Medical Center opened because of the shortage of resources (Richard A. Webster and Katherine Sayre). Theses people who suffered from substance or mental health issues could have led healthier and longer lives but now they have to die in despair due to the inadequate help for the poor.
Poor mental health also leads to physical health problems. People with mental illness are often not able to pay attention to taking precautions against diseases. Thus, even though these homeless can be placed into housing, they still do not have the ability to live a stable life and will finally lose their “home” again if they do not have access to continuous treatment and services (Mental Illness and Homeless). Also, more than half of the homeless people do not have any health insurance (Hwang, Stephen W, et al.). When people have insurance, they are more likely to go to hospitals when they don’t feel well, but for the poor homeless, they do not go to the doctor’s until they get very, very sick because of the fear of expensive bills. Take a cold for example, it might not be a big problem for normal people, but for the homeless, it may lead to serious diseases like pneumonia or myocarditis under poor living conditions and irregular eating habits without proper treatment.
Fortunately, Medicaid expansion under the Affordable Care Act (ACA) was enacted at the start of 2014 (Barriers to Homeless Persons Acquiring Health Insurance Through the Affordable Care Act). For homeless people who often have higher probability to suffer chronic diseases like diabetes, cancer and HIV, it would be extremely beneficial to improve their lives’ quality. What is more, hospitals and state budgets will also gain credit from this action. Lack of health insurance in the homeless population results in their greater use of the emergency department (ED), which seems like their only health care access point. It in return makes an overloading in ED and higher overall cost (Barriers to Homeless Persons Acquiring Health Insurance Through the Affordable Care Act). Besides, as mentioned earlier, people without health insurance do not show up until they have extremely serious health problems, which also makes them stay longer than the average. For the hospitals, it is not only hard to discharge them since they have nowhere to go, but also impossible to have them pay their bills whereas the chronically homeless always have the most expensive medical bills. These situations can get better with Medicaid expansion. Fewer uninsured, extremely sick homeless people will visit the emergency room, and a cheaper, better “safety net” is also provided to the homeless (Arit John). At the same time, Medicaid expansion could also free up money for nonprofits to put towards housing instead of health care.
However, any benefits of the ACA on improving health care require that individuals actually enroll in the program. Healthcare for the Homeless reported that 10% to 50% of their clients were eligible for Medicaid but had not enrolled (Barriers to Homeless Persons Acquiring Health Insurance Through the Affordable Care Act). This is partially because that homeless people have less probability to have access to communicate via phones, computers or e-mails. According to the research, “Not being aware if they qualify for Medicaid” was the most common(70%) and most significant barrier to enrollment. Some needed homeless even never heard of the ACA, which is due to the lack of education in ACA (Barriers to Homeless Persons Acquiring Health Insurance Through the Affordable Care Act). If it is possible to provide this kind of information in every shelter or on the street where homeless are more likely to appear, it would be a better resource for homeless people who barely have any source of information and feel helpless in their lives. Also, if people want to be proved as eligible, they often need to fill a lot of paperwork which sometimes prevents the non-educated homeless population from taking advantage of the system. It would be more humane if we could simplify the complicated systems and give people easier access to health care and treatment.
Problems still appear after the homeless get medications. “For those who are mentally ill — a group that accounts for nearly one-third of the homeless population — receiving and keeping prescription medication can be a daily struggle.” (Celeste Alvarez) Many prescription drugs such as anti-depressants, have high value on the street and are often stolen for resell. As Alvarez mentioned in his article, some homeless are in wheelchairs. They cannot fend for themselves and the only thing they can do is to let the theft steal their medication. In many cases, however, it is impossible for these mental-ill persons to get a refill since most doctors would deny if they suspect the client would be selling or abusing their medication (Celeste Alvarez). It actually not unreasonable because most of population have previous substance use problems but we have to find a suitable solution to help those who really struggle for the loss of their medication to not prevent them from their hard-won treatment.
In conclusion, homeless people still face tough living environment and suffer from starvation and diseases. Although some actions that have already been taken did give help to some of them, there are still problems existing and the deaths rate is still rising. Not only the government has to find better solutions to support their safety and health, some nonprofit organizations and each individual is also supposed to help build a cost-effective system to provide more help to the mental and physical illness.