Posted on May 25, 2011
This week’s blog was written by Robin Gahan, Program Manager for the Virginia Coalition to End Homelessness and former VSH intern.
“Housing is a human right.”
“Homelessness is a public health issue.”
“This is not an issue of who is deserving or undeserving, but a matter of life or death.”
Statements such as these are heard now more than ever before as the growing concern about the vulnerability of persons experiencing homelessness is resonating across the globe. The examination of homelessness, housing, health, and mortality have increasingly appeared in the literature across a range of fields including social work, medicine, psychology, and public health. According to the National Health Care for the Homeless Council (2008), persons that are homeless are three to six times more likely to become ill than those who are housed and are three to four times more likely to die than the general population (O’Connell, 2005). As a social worker, I am called to challenge social injustice and feel passionately that a world that tolerates the death of people living on the streets without housing is unacceptable. While serving as an intern at VSH, I had the opportunity to see the Housing First philosophy in action, a philosophy that is client-centered and has successfully kept the most vulnerable people housed.
While there is a great deal of research available on the impact of housing for persons that are homeless with mental health and substance use issues, there are still significant gaps specific to housing’s impact on physical health. At VSH, the support staff expressed concern about the rate of resident deaths related to health issues. It became apparent that there are a number of formerly homeless adults who are aging and/or medically frail living in permanent supportive housing. While housing can decrease certain risk factors such as exposure to frostbite and hypothermia, long-term chronic illnesses such as end stage renal disease or diabetes do not decrease simply as result of being housed. With the support of VSH, I sought to conduct an agency-based needs assessment to determine the health needs of persons once housed to enhance existing services and increase the programmatic response to physical health needs of persons living in permanent supportive housing.
Through secondary data analysis, I found that since 1997, 30 known residents have had serious health issues that resulted in their death, almost 50 percent of which have occurred in the past three years. The mean age of residents at their time of death was 55 years old. Second, I administered a modified version of the Vulnerability Index, designed by Dr. Jim O’Connell and Becky Kanis. I found that all participants surveyed reported having a disability, 75 percent reported a substance abuse related disability, 63 percent reported mental health disability, and 75 percent reported a physical disability. The most frequently reported physical illnesses included hypertension, arthritis, diabetes, and heart disease. Other responses included kidney disease, hepatitis C, osteoporosis, COPD, asthma, stroke, epilepsy/seizures, and emphysema.
I then conducted eight qualitative interviews with current residents in order to engage in more open dialogue and learn how each individual defined their own health and their perception of need. From the interviews, the following themes emerged: (1) loss and changes to physical ability, (2) impact of physical health on mental health, (3) access to services in the community, and (4) satisfaction with support and additional needs. Overall, those surveyed expressed high levels of satisfaction with agency support received. However, when asked how health needs could be better met, participants provided suggestions that would require services to more directly address health through increased on-site health screenings and classes, available medical equipment, and on-site medical expertise such as a registered nurse. In conclusion, it is hoped that the dissemination of this study will be utilized to enhance existing services and increase the programmatic response to physical health needs of residents living in permanent supportive housing.
I am deeply grateful to the men and women with whom I had the pleasure to interview for my study. Thank you for allowing me the opportunity to share your story, to better understand your needs, and for providing authenticity to a highly controversial issue. I would also like to thank all of the social workers, peer specialists, and support staff that assisted me in collecting data, selecting residents for interview, and patiently tolerated my barrage of emails. Last but not least, a sincere thank you to Kristin Yavorsky, the VSH Director of Support Services who not only brought this issue to the forefront of my mind, but whose wisdom and support of my learning process allowed me to take on this endeavor.