By Meg Grady
In June, outreach nurse Donna Kelly attended to an elderly homeless woman near the Convention Center whose foot appeared to be injured, swollen, and infected. The woman, who showed signs of mental illness, resisted aid, which resulted in calls to the Cleveland Police Department and EMS. When the ambulance arrived, one Emergency Medical Technician told Kelly-who has been an outreach nurse for years-that there was nothing really wrong with the woman and the hospital was too busy to see her. “Lady, I’m talking from realities here, “he said. “She needs a primary care doctor.” Meanwhile, his partner had unwrapped the plastic bag from the homeless woman’s foot and discovered that the top of her foot had been amputated no more than a week before. The wound was infected and festering, and the woman needed immediate hospital attention.
Upon the woman’s arrival, the two separate emergency rooms at the hospital-medical and psychiatric-argued over who should take care of her. She was refused admittance and was instead released onto the street that night. Outreach workers were unable to locate her for a week, and when they finally did, she was in the same condition that she had been when they first found her. She was again transported by ambulance to the hospital, which finally admitted her. It was expected that she would be transferred to a nursing home.
The incident is a perfect example of the many barriers that homeless people face when seeking health care. Many can’t find care until the situation has become dire, and a trip to the emergency room is often the only option. Hospitals will allow patients-amputees, even-to simply walk out of the facility with no idea how to properly care for themselves. What’s more, it is difficult to obtain health care without health insurance, which virtually doesn’t exist in the lives of homeless people. While some primary care physicians can be seen for free at community clinics, the centers are overloaded and lines are long.
Those people in the United States lucky enough to have homes, jobs, and health insurance know what it’s like to have security. Many of Cleveland’s homeless community have a hard time finding stability. And without it, good health is a hard thing to come by.
A May 7 story by investigative reporter Tom Meyer on WKYC-TV covered the large number of EMS runs to the 2100 Lakeside shelter. The story, which was titled “’2100 Club’ costing taxpayers a bundle,” said that Cleveland safety forces responded to over a thousand 9-1-1 calls from the shelter last year. It included quotes from two EMS workers and Cleveland’s public safety director, but didn’t approach the issue from the other side. What do homeless advocates and shelter workers think about the issue?
The vast majority of 9-1-1 calls from Lakeside are not unnecessary, says Kelly, who works for Care Alliance, Cleveland’s health care for the homeless. “Any place that you have a large group of poor, unhealthy, disenfranchised people, you’re going to have a lot of 9-1-1 calls,” she said. Some people believe that calls could be cut down if shelter staff included a nurse or doctor, but she disagrees. “Even if you were to put a doctor or nurse in the shelter 24/7, it wouldn’t reduce the number of calls-they would problems that need to be dealt with,” she said.
Kelly says that there is a serious need in the homeless community for education in health literacy and preventive medicine, and is working to fill some of that need. In October 2007, she started a book club at 2100 Lakeside that has allowed discussion of health-related topics among its participants. In addition, a children’s health literacy class is in the works at West Side Catholic Shelter. The class will be mandatory for all residents and will break health care-related topics down to a level that everyone can understand. Finally, efforts are being made to get a nutrition and preventive medicine class off the ground at 2100 Lakeside.
There is a great need for a formal assessment to evaluate the health care needs of the local homeless population and to document current barriers in accessing care and treatment. The Northeast Ohio Coalition for the Homeless is currently trying to secure funding for such a study, and if possible, wound use the results of the assessment to develop a health care advocacy agenda and an implementation plan with recommended action steps to fill the gaps in service delivery.
Copyright Homeless Grapevine Issue #85 in July-August 2008 Cleveland Ohio