Homeless people face barriers to health services as diverse as the homeless population itself: no bed rest after surgery, no refrigeration for medication, fragmented care from an ever-changing array of doctors, limited transportation and little to no protection for personal belongings.
Robyn Leach, 51, who has lived on the streets in Phoenix for more than a decade, has never been able to keep a month’s supply of medication for longer than a week.
“Being homeless, it’s really hard to keep your medication,” Leach said. “Your things are either stolen or lost on an almost daily basis. So that’s one of the biggest things in taking care of our health out here, is just keeping our medications and not having people steal them from us.”
Leach’s experience with health care — stolen medicine, an ever-changing list of doctors, emergency room care — reflects the reality of health-care for those living on the streets.
Many people living on the streets end up calling 911 or going to an emergency room for a medical problem that could have been treated as part of preventative or routine health care. Left untreated, these problems escalate and require extensive, costly care.
“I’ve had to call 911 for a breathing treatment so many times just because I didn’t have my rescue inhaler because someone stole my purse,” Leach said.
This means that emergency departments bear the weight of providing health care for many homeless people, according to Amanda Davisson, a unit supervisor at the Arizona Department of Child Safety who has been a social worker for 10 years.
“People who are routinely homeless, who routinely have contact with the system … are not accustomed to routinely taking care of things,” Davisson said. “They just live crisis to crisis.”
“Using emergency rooms as your doctor is very expensive for society,” Davisson added.
There are roughly 11,700 people experiencing homelessness in Maricopa County, according to the 2016 Current Status of Homelessness in Arizona report. However, this number can be difficult to quantify because homelessness is a often a temporary condition, not a permanent one.
“Phoenix [is] the largest metropolitan area in the state, so we probably have the best system of care available,” said ASU social work professor Bonnie Ervin. “However, it’s still a difficult population to serve, and what ends up happening is their care ends up being very fragmented, not because the care isn’t available, but due to the circumstances that they find themselves in.”
Ervin, who also works with the Student Health Outreach for Wellness clinic in downtown Phoenix, explained fragmented care as a patchwork of services provided by inconsistent doctors and clinics.
It can stem from several issues that often accompany homelessness: lack of proper identification, lack of medical records, lack of transportation, mental health issues and inconsistent access to phones — which makes making and keeping appointments difficult.
There are also barriers to medical treatment itself.
“Frequently the treatment option that we want to recommend … can be difficult to impossible for the patient to implement,” Ervin said.
She provided the example of a woman at a local clinic who was given a foot bath to treat infected sores. However, the shelter the woman stayed in would not accept the basin as it was not a permitted item.
“We’re trying offer them the same treatment option we would offer anyone, but we have to look outside the box,” Ervin said.
Even though many health care clinics that serve homeless people are trying to divert them from emergency rooms, the clinics can usually only provide similar “emergency-style” care, according to Davisson.
“We need regular preventative care, but how do we do that with people that don’t have a regular residence or ability to maintain records, or maybe don’t even have an ID?” Davisson said.
This is one challenge that many local clinics face.
“Our patients will come in and they’ve seen so many doctors, so they’ve had so many different prescriptions, and some of them are the same prescription at different doses,” said Mary Saxon, the director of operations at the Student Health Outreach for Wellness clinic. “So it’s really hard for them to adhere because they’ve been told so many different things.”
Robyn Leach has experienced this firsthand. She describes homeless clinics as “like going to an urgent care.”
“They’re walk-in services, so you don’t get very personalized service because of that,” Leach said. “They see so many homeless people, and we usually don’t follow up with the same doctor, which is what doctors want you to do.”
Contact the reporter at Anya.Magnuson@asu.edu.