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For Homeless Californians, The Doctor Is Often The ER — Street Medicine Aims To Change That

 September 30, 2019 at 10:47 AM PDT

Speaker 1: 00:00 The homelessness crisis in California gets labeled a public health crisis time and time again, but for those living at homelessness as a personal health crisis multiplied more than 100,000 times over statewide. Our California dream collaboration is looking at solutions to some of the problems facing this state. Matt to NOCO of KPCC has this story from LA on how outreach workers are addressing some of those health needs. Speaker 2: 00:29 It's a hot September morning and I'm walking down a street in Venice, Los Angeles with dr Coley King. Here's third in rows. It's a sprawling block, long homeless and camp met with maybe 30 tents under the beating late morning sun Kings, one of the doctors in LA County who practices what's called street medicine. Speaker 3: 00:47 These patients are very sick. These patients die very young. They need medical care. It's let's get better medical care to them and let's give them a better medical home that they can come into. Speaker 2: 00:57 King works out of a nearby free medical clinic that he refers all his patients to living on the street shaves 30 years off a person's life expectancy. The median age of death outside is about 52 the goal of street medicine is there proactively include people in a healthcare system that's otherwise inaccessible until they hitch a ride in an ambulance to the ER. Speaker 3: 01:17 And how have you feeling now on these medications? I love these medications cause I'm not tired. Speaker 2: 01:23 Shawnda Thorton has been on several of those expensive hospital trips since she was diagnosed with congestive heart failure back in January. Speaker 3: 01:30 I feel when they walk a block or two I'll feel fine. I could walk all the way up to the 99 cent store and back. Speaker 2: 01:36 She's in her forties and has been in the hospital more than not this year. Speaker 3: 01:39 September is the first month that I have it. Speaker 2: 01:42 Sean does conditioned would be challenging even if she wasn't homeless. She was given a defibrillator vest and instructions to always aware it. But it malfunctions. SG sweats through the summer, living inside her nylon tent. Speaker 3: 01:53 It would say that I was having a heart attack, but I was just really perspiring a whole lot. Speaker 2: 01:57 So she keeps the vest in its box in a shopping cart beside her tent. She doesn't have a place to charge it. Speaker 3: 02:03 It's like a pain and trying to keep it, keep it going. Speaker 2: 02:07 So Dr. King works a compromise, stay on her meds, get checked up in the clinic every now and then and make sure her encampment, neighbors know to call nine one one if they see her in trouble. For Dr. King, the goal is to ensure Shonda has access to ongoing medical care that keeps her out of the ICU. Speaker 1: 02:25 Street medicine has been a vehicle to stop the bear go around a little bit. Speaker 4: 02:29 Corrine Feldman is a USC researcher who studies health outcomes for homeless patients. Reducing the Merry go round trips in and out of the hospital by homeless people is basically the main reason there's more medical practitioners working on the street everywhere in the state than there ever has been before. LA County has almost 40 teams on any given weekday reaching homeless people where they are. Speaker 1: 02:50 There's a multitude of reasons why they might legitimately want to access that care, but they legitimately cannot. Speaker 4: 02:55 Research shows that street medicine can encourage patients to more regularly seek medical attention that can lead to reduced ER visits and greater overall trust between patients and homeless outreach providers. The reality is though, people are going to be on the street for the foreseeable future. Speaker 2: 03:12 King says Californians need to look beyond the garbage and the tents and to really see the people out there who are struggling to survive Speaker 3: 03:18 the pitfall of labeling a public health crisis. It becomes a reactionary, not in my backyard issue where it doesn't need to be that that's, that's not what this is about. This is about the individuals who are sicker than the rest of us and are dying sooner than the rest of us. Speaker 2: 03:33 That is the squalid conditions on the street are mostly a risk for those who live in them. Not so much the rest of us. As for Shonda when it comes to getting off the street, she's actually doing better than most. Speaker 3: 03:45 Right now I'm searching. I have a voucher. I'm searching for housing. Speaker 2: 03:49 A public housing voucher is a major step towards finding a home. The next is actually locating and somewhere to use it. Her problem is just that she's been sick though. She's had several appointments to meet with property managers. Speaker 3: 04:01 Every time I had an appointment or something I would be in the hospital, Speaker 2: 04:05 which means her voucher is now close to expiring. Dr King's job is to make sure she stays on her meds, stays out of the hospital, and actually has time to find a place to live. The street is no place to heal. Speaker 3: 04:17 You can work on it. This is certainly a place to start working, but to fully heal around here, I don't think, I don't think it's possible, Speaker 2: 04:26 but it's the only place Shonda has to start Speaker 1: 04:29 joining me is KPCC reporter Matt to Noko and Matt, welcome to the program. Hi, thank you for having me. Now your comment that squalid conditions on the street are much more of a health risk for the homeless than for the general public. We certainly found that out here in San Diego during the hepatitis a outbreak. That disease stayed almost entirely within the homeless community. So is there a lot of talk that public health is at risk from homeless encampments Speaker 4: 04:59 locally, at least in Los Angeles County that has been brought up several times over the past. Really the past year there've been a couple of court cases and then sort of in the lead up to the rulings on those court cases. Uh, there's been a sort of PR uh, effort to tie homeless encampments to a general wider public health of, of people who are not homeless and say that these encampments are risks for the wider public and people should be worried about getting sick because of the conditions on the street. The, the problem is, is that when, as I've actually poked into some of those cases, is that it hasn't really born out. And the reality is, is that for the rest of us, those of us who are not homeless, we can go home, we can take a shower, we have access to regular regular medical care. It doesn't pencil, at least in what I've been able to find out. Speaker 4: 05:44 And, and that involves basically reaching out to the local County health departments. The flip side is that for the people who are actually living in the encampments, they don't have running water, they don't have a way to clean up, they don't have access to regular medical care, and they're the ones who are living in these conditions. So it is much more of a risk. Like if we walk by in and camp man and go home and take a shower, the wool that's were clean. Whereas if I'm living in new continent, that's not, it doesn't pencil that way. What are some of the most frequent medical complaints from people living on the street? Really anything that you or I can get sick with will will happen outside. One of the things that's most common I know is pneumonia because it's, say somebody gets the flu, but then they're living outside and maybe it's winter, so they're always cold and if it's been railing then they're always a little bit wet and that makes it very hard. Speaker 4: 06:27 And then really the, the one of the major things that happens outside is, is compounded physical trauma. So say you fall and break a bone. The problem is is that you're not gonna go to the ER necessarily and have that bone reset properly so it might, it might not heal correctly. And then that turns into a sort of latent disability that lasts longer. So say, well actually when I was reporting this story, we met one woman who, she had her broken collarbone. The collarbone was beginning to heal though, but it wasn't healing in a way that she would have been able to really use her right arm. So it would have compounded into a physical disability and that that happens a lot. So some people get hit by cars, people get assaulted, and then the injuries compound into a physical disability that ends up affecting them for the remainder of their life. Speaker 4: 07:11 You said in your report that being homeless takes about 30 years off a person's life expectancy, which is just a tragic situation. I know the reasons for that may seem obvious, but could you break them down a bit? What are some reasons why being homeless causes such a threat to life and health? So there's everything that we just said. Uh, but then just living outside is extremely stressful for a human body to take. So that stresses is you have your elevated cortisol levels and that just wears on a body. Then another one is just sleep deprivation. This is one of the things that I try to underscore a lot and says, okay, if you're living on a sidewalk next to say a busy street, you're never ever going to be able to actually get into a deep sleep. Mostly because, I mean you want, you could be worried about getting hurt or something. Speaker 4: 07:59 But then also just to say somebody with a loud muffler drives by, so you're gonna get constantly woken up. Nobody who's living outside gets a restful night of sleep and now you compound that over one day or, or a week or a month or a year. That's also just wearing down a body to the point that your immune system can't respond as well as it necessarily would be able to if you were. Um, and then all that, and that just compounds into that 30 year shorter life expectancy. More or less. Now here in San Diego we have street health teams as well. One started by father Joe's villages. We also have doctors in training at UC San Diego who set up street clinics to treat the homeless. Are there also teams from different agencies working in LA? There are, so with our measure H funding, the sales tax measure that LA County voters passed a couple of years ago to fund homeless services. Speaker 4: 08:51 We're funding a variety of different health responses to homelessness. Some hospitals will fund little street outreach teams. Some of it comes from the mental health departments. Other comes from the public health departments, but the key is basically just making sure that when our homeless outreach teams go out, there are medical providers on there. Now I know there was a big push several years ago to try to get homeless people who are using emergency rooms frequently into supportive housing. The idea being it's going to be better for the people who are homeless and it's going to save an awful lot of money. Where does that effort stand? So supportive housing, supportive housing model is still the sort of modus operandi for how we're dealing with homelessness in California. It is basically designed to take people who are on the street and have been deteriorating for a very long time and put them inside and basically give them everything that they need to get better. Speaker 4: 09:43 That is still our model and what we are doing to address homelessness. The problem is just that supportive housing units are costly to build and they take a while. Meanwhile, you have more people falling onto the street and also continuing to deteriorate. The, the challenge is how do you create supportive housing units more quickly and more inexpensively than how we are doing them right now. So that's really where we are right now is how do we build housing units that are of a high quality and relatively inexpensive to deal with the increasing numbers of people falling onto the street and then continuing to deteriorate. I've been speaking with KPCC reporter Matt to Noko and Matt, thank you so much. Thank you. Speaker 5: 10:25 [inaudible].

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Instead of trying to powerwash the problem away, California’s hospitals, public health departments, and homeless service organizations are increasingly sending trained health practitioners into homeless encampments in a quest to improve health outcomes for individual homeless people.
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