Last month, news of Hawaii’s homeless challenge gained national attention on HBO’s Vice News (Hawaii News Now, 3/30/17). The 5-minute segment spotlights that “Hawaii legislators are debating whether to classify homelessness as an illness and housing as a treatment. (via HBO).” This Vice News report is not the kind of attention that Hawaii wants, but maybe it’s the attention that Hawaii needs.
Correspondent Caroline Modarressy-Tehrani interviewed four people to get their perspectives on the proposal to redefine homelessness as a medical condition. Gary Grinker, who is chronically homeless and has a heart condition; he visited the emergency room 241 times in 2016, costing taxpayers $1.2 million in healthcare. Senator Josh Green, who introduced a bill to redefine chronic homelessness as a disease and allow doctors to write prescriptions for housing. Representative Bob McDermott, who believes that Hawaii has “turned the safety net into a hammock.” And Dr. Daniel Cheng, an emergency room doctor at Queen’s Medical Center, which handles two-thirds of all homeless encounters in Hawaii.
I had three successive reactions to the news report.
First, doctors’ first responsibility is to take care of patients’ physical and mental health. A “prescription” for housing would probably involve time filling out forms and coordinating with social workers – time that doctors need to help patients.
Second, having a home may not make people more responsible for their health or reduce emergency room visits. It may even exacerbate health conditions, if people have health emergencies in their home and are unable or unwilling to seek help.
Third, if a solution to rising healthcare costs and chronic disease were housing, we would have more people living in shelters and healthier people at home. But in Hawaii, an alarming 82% of adults have at least one chronic disease or condition and 53% have two or more chronic diseases (heart disease, heart attack, stroke, diabetes, asthma, disability, cancer, chronic obstructive pulmonary disease, high blood pressure, high blood cholesterol, or obesity), according to the Department of Health’s “Chronic Disease Disparities Report 2011: Social Determinants.”
Instead of a “prescription” for housing, maybe doctors should write a “prescription” for a job. Research shows that employment increases health status and healthy people are more likely to work, according to a Lead Center Policy Brief, “The Impact of Employment on the Health Status and Health Care Costs of Working-age People with Disabilities” (2015).
“Work is at the very core of contemporary life for most people, providing financial security, personal identity, and an opportunity to make a meaningful contribution to community life,” according to the National Alliance for the Mentally Ill (NAMI) factsheet, “Facts about mental illness and work” (1999).
A job gives people dignity as well as a paycheck. Doctors can assess a person’s physical and mental ability to work, and offer a referral to an employer – who could assess their skills, experience, and trustworthiness.
Do you think that we can reduce healthcare costs by prescribing housing? Could having a job help people be healthier?