Two of the most controversial and debated policy areas in California today are affordable housing and health care. But those two issues – and their solutions – are deeply linked.
In few places is that better illustrated than Santa Clara Valley Medical Center’s Homeless Healthcare Program.
As a resident physician at VMC, I had the privilege of spending two weeks with the homeless program, rotating between clinics at the Reentry Resource Center (for those recently incarcerated), the Bill Wilson Center (for homeless youth), and several specifically for homeless residents. These included, in San Jose, the HomeFirst shelter on Little Orchard Street and the program’s clinic on Alexian Street, and at the Gilroy Compassion Center. We also treated seasonal farm workers in the fields and homeless patients on the streets.
At each site, I saw the value of providing housing, particularly for those who have complex medical needs — including addiction. A lack of housing meant patients didn’t have a safe place to store medications, couldn’t establish regular routines and were at risk of spending time with those who encouraged them to get back into using illicit substances.
Housing provides immediate stability and independence, and this stabilizing force can lead to vastly improved health outcomes.
Traditionally, housing programs for the homeless – particularly those run by the government – have required that patients “get clean” before they can earn housing. But that view has been changing.
A seminal study on homelessness in 2015, for instance, showed that patients randomized to housing-first care rather than traditional care were two to three times more likely to remain housed over two years. Some studies have also shown that focusing on housing first leads to long-term cost savings. But studies only start to paint the picture.
Homeless patients face enormous hurdles to improving their care. One of my patients had high blood pressure medications stolen by people who thought they were opiates or thought they could sell them to others who could be tricked.
Several of my homeless diabetic patients couldn’t refrigerate their insulin. One was nearly knifed in her tent at night. One had been riding a wheelchair with no tires for over a year, the wheel ground down to flat plastic about to snap.
Homeless patients require tremendously specialized and multidisciplinary care. The Homeless Healthcare Program employs psychologists, pharmacists, nurses, community health workers, social workers, case managers and more who work in concert to address a single patient’s care.
Providing this complex care takes deep institutional initiative and financial investment. Since there is no requirement for anyone to provide health care to the homeless, few places do it in such a well-resourced, intentional and sensitive manner.
The Assembly Select Committee on Health Care Delivery Systems and Universal Coverage is holding hearings on health care reform, with tremendous pressure to move to a single-payer model. While this debate is important, it doesn’t matter who is paying for health care if it can’t be delivered to the patients who need it.
Ultimately, the experience of developing relationships with my homeless patients has shown me that, once you adopt the radical concept that every human life should be valued equally, the need for a program like this one becomes obvious. Other counties should build on Santa Clara’s model, and the state should view housing and healthcare through the same lens in promoting new models and solutions for homeless Californians.
Dr. Nuriel Moghavem is a resident physician at Santa Clara Valley Medical Center. He graduated from Stanford School of Medicine, is a Trustee of the California Medical Association and was a legislative assistant in the California State Assembly. He wrote this for The Mercury News.
Homelessness, health care crises overlap at VMC