ThinkProgress has dedicated a portion of our coverage on Wednesday, June 29th to reporting on the state of homelessness in Washington, D.C. This story is part of that series.
Washington, D.C. has more than thirty health clinics and mobile medical programs specifically geared toward the city’s homeless. The need is as huge as it is varied — doctors treat everything from poor vision to heart disease on a daily basis — and the city’s expanded Medicaid program helps smooth out most funding gaps.
But only a portion of the region’s 11,600 homeless residents seek out this kind of medical care. For some who haven’t seen a doctor in decades or have a chronic addiction, it’s fear of judgment that keeps them away. For others, it’s the perceived inconvenience of getting a check-up and breaking out of their geographical comfort zone. And for many, it’s an overarching distrust of doctors that dissuades them.
Instead of waiting for their patients to cave in, one physician and one social services expert decided to bring their expertise directly to their clientele on the streets.
It’s about meeting our patients where they’re at, both physically and mentally.
“It’s about meeting our patients where they’re at, both physically and mentally,” says Dr. Catherine Crosland, medical director for the homeless service arm of D.C.’s Unity Health Care.
Crosland has worked in homeless health care for more than a decade, but most of her care has taken place inside sterile clinic rooms. Over time, however, she began to notice the number of homeless people avoiding medical help and seriously suffering because of it. So last month she teamed up with Beau Stiles, the street outreach lead at Capitol Hill Group Ministry, to organize a weekly stroll through the neighborhood just east of the Capitol building’s white dome. Geared with a backpack stuffed with rubber gloves, medication, diabetes tests, first aid supplies, and a stethoscope, Crosland follows Stiles through the neighborhood, stopping to check in with people along the way.
“Hi there, would any of you like a blood pressure test?” Crosland asks a group of men resting against a shaded brick wall on a crushingly hot June day. Some look puzzled by her warmth. Others smile, and bombard her with their current medical problems.
Headaches. Problems sleeping. Chronic pain. Crosland crouches down to address each person’s complaint one by one.
She takes the blood pressure of a man leaning on a cane, who tells her he hasn’t been to a doctor in twenty years. Crosland’s eyebrows jump when she reads the results. “He could have a stroke at any minute,” she tells Stiles, after giving the man medication to temporarily lower his blood pressure. She makes him promise to visit her office tomorrow for a follow-up.http://archive.thinkprogress.org/health/2016/02/10/3747111/aging-homeless-health-issues/Mark, standing nearby, has been homeless since 2008. Medicaid has given him access to medication to combat his depression and high blood pressure. With his health stabilized, he’s just hoping for a stable home. This is Stiles’ specialty: Getting people connected to the network of local social services after they pass Crosland’s check-up. He uses a tablet to keep track of everyone’s current housing situation, health care plan, and general well-being — and meets twice a month with other D.C. homeless service providers to connect those in need with the right services. But availability varies.
Some weeks, Stiles says, he can connect 40 people with long-term housing. Other days, there’s no open rooms at all.
In the meantime, Stiles checks in with the neighborhood regulars on a daily basis, to become a familiar face to his clientele.
“The biggest part of it is building a rapport,” says Stiles. “People have to feel like they trust you before they feel comfortable receiving medical care.”
Crosland agrees — and she’s in no rush to push medical services onto wary clients. “Building a relationship is the first step,” she says. She hopes to use these relationships to expand her abilities to treat patients with mental illnesses — one of the most common health problems in D.C.’s homeless community. While she’s trained in internal medicine, Crosland has been taking classes that can help her screen for psychological diseases while giving a normal physical check-up.
“If a doctor came out here and said they were a psychologist, people wouldn’t let them see them,” Crosland says. “They’d say ‘I’m not crazy!’ But if they already recognize me as a doctor that deals with physical problems, they’ll be more open to talking about more psychological issues with me.”
When people are suffering from mental health issues, they often ask Crosland for medication to help them sleep. When framed as a sleep aid, medication that could quell schizophrenia or other personality disorders doesn’t sound as scary or stigmatizing. But Crosland said she’s not confident enough to prescribe anti-psychotics — yet.
People have to feel like they trust you before they feel comfortable receiving medical care.
Despite their boots-on-the-ground approach, there are still many homeless people who refuse Stiles and Crosland’s help. One man says he wants to free up resources for other people that need it more. Another just shakes his head “no” when Crosland greets him. Many remain skeptical of their intentions. Even connecting people to housing can be a struggle.
“It’s definitely complicated. If a person with serious alcoholism passes out on the street, someone will alert 911, someone will make sure he’s cared for,” Crosland says. “But if he’s in housing by himself, who’s going to call for help? He could just die in his apartment.”
The pair end the afternoon walk with Rick, a man resting in a folding chair in a gas station parking lot. He’s been taking ibuprofen for severe lower back pain, but it isn’t enough — Crosland wants to see him in her office.
“It’s too painful to walk to the bus, I’m stuck on this block,” Rick says, and then chuckles. “Maybe I’ll just lay on the ground and call 911.”
Crosland shakes her head while jotting down notes. “No, we can try something better than that. We’ll figure something out.” Rick is without Medicaid, let alone any form of identification. But Stiles reassures him that he’ll return in a couple days with all the paperwork needed to get covered.
“We’re going to fix this. One step at a time,” he says.
Rick nods. “Okay,” he says. “One step.”