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National Health Center Week 2019: Today's Focus -- Healthcare for the Homeless

The vast majority of community health centers provide care to underserved and vulnerable patients, many of whom experience housing insecurity. Certain health centers also receive federal funding from the Healthcare for the Homeless program to provide targeted services to individuals experiencing homelessness. This program helps serve around one million individuals experiencing homelessness across 300 health centers nationwide, including seven health centers in Tennessee.

The vast majority of community health centers provide care to underserved and vulnerable patients, many of whom experience housing insecurity. Certain health centers also receive federal funding from the Healthcare for the Homeless program to provide targeted services to individuals experiencing homelessness. This program helps serve around one million individuals experiencing homelessness across 300 health centers nationwide, including seven health centers in Tennessee.[1] ,[2]

Individuals experiencing homeless often struggle with poor health. Poor health can contribute to homelessness, but homelessness also worsens health. The connection between health and housing can lead to a complicated cycle that is difficult to overcome. Injuries or illnesses can prevent people from performing their jobs or cause them to miss too much work, which can ultimately lead to unemployment. Without a reliable source of income, it is difficult to afford the medical care that's necessary to treat illnesses or injuries. Extended periods of poor health can make it difficult to regain employment and a steady income. Under these circumstances, it becomes nearly impossible to pay bills including rent or mortgages, which can result in homelessness.[3] Homelessness may mean living on the streets, in encampments or shelters, in transitional housing, or temporarily staying with family or friends.[4]

Homelessness can trigger health problems or make existing conditions even worse. Without safe and adequate housing, people are subjected to chronic stress because they lack basic protection. Individuals experiencing homelessness are also frequently exposed to extreme weather and temperatures, communicable diseases, injuries, and harassment or violence. These conditions make it challenging to access or afford proper medical care and manage health conditions.[5] As a result, people who experience homelessness are more likely to have complex health needs and suffer from acute and chronic conditions that can't be addressed with medical care alone. Compared to the general population, people experiencing homelessness have higher rates of diabetes, high blood pressure, and heart attack and are more likely to be living with HIV and Hepatitis C. They are also significantly more likely to experience mental illness and substance use disorders.[6]

Integrating housing services and medical care can improve overall health and well-being by preventing illnesses and injuries, improving access to health care and social services, and facilitating healthier behaviors. This approach has also been shown to reduce overall health care costs by decreasing the utilization of services like emergency rooms.[7]

Community health centers are uniquely equipped to provide care to individuals experiencing homelessness because their care model integrates primary care with services that address the unique social and environmental needs of their clients. Many of Tennessee's health centers are located near shelters or have mobile units to make care more accessible. At least one health center also provides primary care, behavioral health, and substance use treatment within a day shelter that also has access to showers, washers and dryers, and clothing.

Health centers that serve individuals experiencing homelessness provide primary care with a special emphasis on behavioral health and substance use disorder treatment, along with outreach and case management. Multi-disciplinary care teams help to meet the diverse needs of individuals experiencing homelessness. A typical team may consist of primary care providers, nurses, behavioral health consultants, behavioral therapists, patient navigators, medical care managers, and case managers. Team members work together to address the complex physical and mental health needs of their patients and provide the support they need to navigate the health care and social services systems.

Health centers also leverage partnerships with other community-based organizations like churches, health departments, universities, and social service agencies to more holistically serve people experiencing homelessness. Health centers often rely on partnerships to help conduct community outreach. Programs also link patients to more specialized medical care if necessary and to social services organizations that can provide job training and placement, education services, and housing services.

During National Health Center Week 2019, from August 4-10, health centers across the country and in Tennessee will be raising awareness of their mission and accomplishments. We invite you to show your support for the ways America's health centers are serving people experiencing homelessness by joining us at a health center event in Tennessee. We look forward to seeing you!
 

[1] Health Care for the Homeless - NACHC. 2019. NACHC. http://www.nachc.org/health-center-issues/special-populations/health-care-for-the-homeless/.
[2] Tennessee – States – National Health Care For The Homeless Council. 2019. Nhchc.Org. https://www.nhchc.org/hchdirectory/tn/.
[3] Ibid.
[4] Homelessness & Health: What's The Connection? 2019. National Health Care for the Homeless Council.   https://www.nhchc.org/wp-content/uploads/2019/02/homelessness-and-health.pdf.
[5] Ibid.
[6] Ibid.
[7] Health Care for the Homeless Program. 2011. National Health Care for the Homeless Council. https://www.nhchc.org/wp-content/uploads/2011/09/HCHFactSheetMay2011.pdf.

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