"We should resolve now that the health of this nation is a national concern; that financial barriers in the way of attaining health shall be removed; that the health of all its citizens deserves the help of all the nation."
These are not the words of President Barack Obama but of President Harry Truman in his 1945 Special Message to Congress. As a nurse and an immigrant, I believe America's strength lies in the struggle to achieve the ideal of equal rights for all.
Historically, health care has been least accessible to the poor and homeless. In 2008, the National Health Care for the Homeless Council, or NHCHC, estimated 70 percent of homeless people did not have health insurance. Approximately 14 percent of people treated by homeless health care programs are children younger than 15. A study by the National Center on Family Homelessness lists Oregon as having the highest portion of homeless children of any state in the nation.
Starting on Jan. 1, 2014, the increase in coverage mandated by the Affordable Care Act will mean the majority of homeless people will become eligible for health insurance. The ACA requires states to establish procedures for "conducting outreach and enrolling vulnerable, unaccompanied homeless youth."
Strategies are needed to ensure the provision of health care to underserved groups is effective. A study carried out by two registered nurses studying for their bachelor's degrees monitored a free clinic attached to a soup kitchen in Georgia. They found that most homeless people seek care late in the course of illness. Initial contact with the health care system is typically in a hospital emergency department. Clinic appointments posed a challenge because the homeless often do not possess a phone and are "present-time" oriented. Studies suggest free ("no fee") clinics run by volunteers can play a key role in reducing the impact of homeless health care needs on emergency departments. Unfortunately, until 2010 there were only four free clinics in Oregon and none within a 100-mile radius of Jackson County — the most populous county in Southern Oregon.
However, in December 2010, La Clinica began providing a monthly free clinic attached to St. Vincent de Paul's homeless shelter. It has been very successful. Both La Clinica and the Community Health Center also operate a number of "sliding-scale" health clinics throughout the county that provide access to care regardless of income level or ability to pay. Outreach charities such as the Maslow Project and Hearts with a Mission assist homeless youth with Medicaid enrollment, education, shelter, food and other services.
The Oregon Health Authority initiated its Healthy Kids project in 2009, which was awarded $11 million in "performance bonuses" through the Children's Health Insurance Program Reauthorization legislation for extending the state Medicaid program (Oregon Health Plan) and reducing the number of children in Oregon without health insurance from 11.1 percent in 2009 to 5.6 percent in 2011. Statistics on homeless children's access to health care are not readily available, but it is reasonable to assume Oregon's 34,403 homeless children make up a large portion of the 5.6 percent of children who are still not enrolled in the state Medicaid health plan, despite the majority of them meeting eligibility guidelines.
Federal government grants in the form of Health Care Innovation Awards issued by the Center for Medicare and Medicaid Innovations and philanthropic grants exist to turn local strategies into a reality. For example, earlier this year the YMCA received an $11,885,134 award to fund a diabetic prevention project in 17 communities across the U.S. (unfortunately, Oregon was not one of those communities). The Robert Wood Johnson Foundation announced $2.2 million in grants to nine states as part of the Academic Progression through Nursing program to address the U.S. Bureau of Labor Statistics predicted shortage of 1.2 million nurses nationwide by 2020 (again, Oregon is not one of the recipients — although our neighbors Washington and California are).
There are more than $1 billion in Health Care Innovation Awards available through the CMMI to "deliver better health care and lower the costs of (health care), particularly (to) those with the highest health care needs." One proven strategy to address the health care needs of the homeless is a database of local nurses willing to volunteer to run a free clinic. A delegation of nurses, community leaders and charities collaborating with local hospitals could develop a grant proposal to fund a site and equipment for a free clinic. If you are a nurse in Jackson County, write or email Mayor Gary Wheeler voicing your concern over these issues: firstname.lastname@example.org.
Paul Kirby of Medford is a registered nurse.