Housing as Healthcare

Last February, I was walking home one morning after doing an overnight volunteer shift at a local homeless shelter. I was content as I walked to the metro, thinking about the extraordinary women who lived there and all of the hard work and passion they put into bettering themselves everyday. Together, they created a community of support, love, and empowerment. I considered the couple of nights a month that I spent with them an honor.

Later that day, however, I noticed that something was wrong with my health. I had developed a painful spot on my skin. Eventually, I would learn that I had likely picked up methicillin-resistant staphylococcus aureus, or MRSA, from the shelter. MRSA is “a bacterium responsible for several difficult-to-treat infections in humans,” and a common cause of cellulitis amongst homeless populations. The Boston Health Care for the Homeless Program (BHCHP) reports that the homeless population is predisposed to this condition due to a variety of factors, including: “chronic malnutrition, lack of adequate rest, communal living with exposure to communicable diseases, limited access to showers, and poorly controlled chronic medical illnesses.”

In the end, what had started as a painful spot on my skin turned into one trip to urgent care, two trips to the emergency room, two prescriptions for antibiotics, taking sick days off from work, a major blow to my immune system, and a good chunk of general nausea and discomfort. It also, regardless of the fact that I am lucky enough to have health insurance, left me with a slew of medical bills that resulted in a handful of monthly payment plans that I’m still chipping away at eight months later.

Amidst the financial and physical stress that the event caused me, I began to think about the women in the shelter—the ones I so adored. If my body, with a strong immune system and proper shelter and care, had such a hard time fighting off this infection, then I could only imagine what it would be like if I did not have proper resources for self-care, or if my immune system was already compromised by a chronic illness. If, with health insurance and a job that provides me with paid sick leave, going through this temporary lapse in health hit me hard financially, I could see how it could throw a family living paycheck to paycheck out of stability and into homelessness.

As part of its discussion on the occurrence of cellulitis within homeless populations, BHCHP writes:

Salit and colleagues compared lengths of stay and reasons for hospitalization among homeless and other low-income persons in New York City to estimate costs associated with homelessness. Skin disorders, including cellulitis, accounted for 8.4% of homeless admissions, but only 4% of admissions for poor housed patients and 3.7% of admissions to private hospitals in NYC. The mean length of stay for the homeless patients was 3.4 days more than for private patients and 1.8 days more than for the poor housed patients.”

And it’s not just cellulitis that has a lower rate for housed people than for people experiencing homelessness. Liver conditions, chronic bronchitis, tooth loss, and mental illness are just a few more examples of health issues that plague a higher percentage of people experiencing homelessness than those who are not.

So, why is it so important for us to heed these statistics? The answer is because, as many research and advocacy groups are promoting more and more, these numbers show that housing is, in fact, healthcare. It is the first important step to a healthier society. It gives people the chance to have a space in which they can actually focus on their health.

In a recent article, Amy L. Freeman of Bethesda Cares writes about this topic, sharing a moving story about one of her organization’s clients who, upon finally receiving housing, was able to start taking his medication to control his congestive heart failure. The reason this man couldn’t take it while living on the streets is because the medication was a diuretic, and people living on the streets don’t have readily available access to things most of us take for granted—such as a toilet.

Freeman further illustrates the need to see housing as healthcare when she writes:

“How is the homeless woman with diabetes supposed to refrigerate her insulin? The man with high cholesterol, but no kitchen, to cook himself low-fat meals? People coping with both the frenetic uncertainty of life on the street, and with constant exposure to the natural elements are at abnormally—and avoidably—high risk of physical suffering, and premature death from treatable causes.”

There is clearly a moral argument for providing housing to our nation’s most vulnerable, but there is also an economic one, and the economic argument largely circles back to the healthcare system.

Photo by: Kate Brown

In 2006, Malcolm Gladwell wrote a piece for The New Yorker called “Million-Dollar Murray” that drew upon the story of one homeless man in Reno, Nevada to make an argument for Housing First, which the National Alliance to End Homelessness describes as “an approach to ending homelessness that centers on providing people experiencing homelessness with housing as quickly as possible—and then providing services as needed.”

This homeless man’s name was Murray Barr, and he spent the majority of his life living on the streets. In 2003, the Reno Police Department “totted up all of [Murray’s] hospital bills for the ten years that he had been on the streets—as well as substance-abuse-treatment costs, doctors’ fees, and other expenses” and realized that Murray “probably ran up a medical bill as large as anyone in the state of Nevada.” Gladwell quotes one of the police department’s officials as saying, “It cost us one million dollars not to do something about Murray.” Later in Gladwell’s article he explains, “It would probably have been cheaper to give [Murray] a full-time nurse and his own apartment.”

When people do not have access to preventative healthcare, or the means to pay for services, they end up in the emergency room, and those costs get passed on to the rest of the community. And when they’re released, if they’re released back onto the streets, the odds are that the cycle will continue, and the emergency room will soon see them once again.

Getting sick after one of my stays at the shelter was an eye-opening experience in many ways. Now every time I make a payment on one of my medical bills, my heart aches for the far too many individuals and families in our nation whose health struggles far surpass my own brief encounter with the stress they must face on a regular basis. Economically, morally, and simply for the health of our nation, the answer is clear. We need to start seeing housing as healthcare.

Click here to view more of Kate Brown’s photography and work.

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