Homeless struggle for health care
Indigent are most likely to get sick or injured but rarely have insurance

An ambulance waits for its next assignment outside Mercy Medical Center on Tuesday. Many people without access to health care or without insurance end up in Mercy’s emergency room as a last resort./Photo by Todd Newcomer.

Two years ago, Bruce Deile was diagnosed with Lyme disease during a stint in Santa Rosa, Calif. At the time, he was given a three-week course of antibiotics to treat the disease, but according to Deile, “it didn’t seem to kill the infection.” The 38-year-old said that the disease is currently inflaming his brain and spinal cord and, if left untreated, could paralyze or kill him.

“After being diagnosed, I traveled to seven different states and can’t get the intravenous antibiotics that the National Institutes of Health say bring full recovery,” Deile noted.

Deile said he believes he can’t get the medicine in large part because he is homeless, has been for the last six years and can’t afford the expensive treatment. Deile’s quest for health care arrived in Durango two months ago, joining numerous others without housing or health insurance who face a steep path to recovery. This picture may worsen before it improves.

John Gamble, Volunteers of America division director and supervisor of the Durango Community Shelter and the Southwest Safehouse, said that the homeless population faces a doubly hard health picture. First, they are often more susceptible to health problems.

“There’s a vulnerability in the sense that you’re often living in the street, your nutrition is less favorable and in the case of some homeless people, your lifestyle choices are less favorable,” Gamble said. “There are people who every winter live in stick and canvas lean-tos in the hills, and those people are vulnerable.”

Second, these people who are most likely to get sick or encounter health problems are also least likely to have health insurance coverage.

“The lack of access to health care for low income and homeless people is really a reflection of a growing national problem,” Gamble said. “Durango is full of employers who don’t supply health insurance. At how many hundreds of dollars a month does it become feasible for a homeless person to even think about having health coverage?”

The net effect is a situation that spirals downward to a disastrous end, according to Gamble and Teresa DeGuelle, program manager for the VOA Community Shelter.

“One of the biggest issues is that these people may fall ill, but they don’t get treated and it spirals into a more serious condition,” DeGuelle said.

Gamble added, “You end up having folks who may delay access to health care for one reason or another and they’ll wait until they get sick and go to the emergency room. And we all know that the emergency room is the most expensive health care you can pay for.”

And while the common perception of the homeless person is of a male drifter with a substance-abuse problem, Gamble said that Durango’s homeless population does not fit the stereotype. Instead he pointed to a large number of local individuals and families who have fallen on hard times. Deile also contrasts the stereotype and is proud of the fact that he has been clean and sober since 1985, long before he became homeless.

John Gamble, of the Volunteers of America
Community Shelter and the Southwest Safehouse, talks about the state of health care for the homeless. He said problems with health care access also impact low- and middle-income segments of the local population./Photo by Todd Newcomer.

Gamble also commented that 40 percent of Community Shelter residents are women and children, and that all of the residents of the Southwest Safehouse are women and children. With these factors in mind, he said that the lack of health-care access is particularly upsetting.

“We have a large number of children in this community with no access to health care and that’s so wrong,” Gamble said.

He added that health care access may be visibly difficult for the local homeless population but also impacts low- and middle-income segments of the local population. “I think it’s important to recognize that this is a problem demonstrated in the homeless community, but experienced by working families all over this city, state and nation,” he said.

Despite an apparently bleak health-care future for these segments of the local population, Gamble said that Durango does have an upside. Mercy Medical Center’s open-door policy does offer some hope.

“I can’t say that I’m aware of people who are homeless and dying on the streets,” he said. “The medical safety net in this community is Mercy. When all else fails, they will pick up the pieces.”

David Bruzzese, spokesman for 4 Mercy Medical Center, commented, “We’re the safety net for everyone, homeless or not. If you can’t afford health insurance, it doesn’t matter to us. We serve everyone regardless of their ability to pay.”

To this end, Mercy wrote off $3.9 million in unreimbursed Medicaid and Indigent Care costs during the 2003 fiscal year.

“What distinguishes us is, we are open 24 hours a day and care for everyone who comes through our doors regardless of their ability to pay,” Bruzzese said.

The one caveat is that the care is only for people who come through the emergency room doors with an immediate life-threatening condition; there are no provisions at Mercy for indigent primary care. Three weeks ago, Diele went to the Mercy emergency room seeking treatment for complications from his Lyme disease. At that time, he did not receive the intravenous antibiotics he says are necessary.

“I’ve gone to the emergency room most recently here in Durango because of the neurological manifestation of the disease,” he said. “I’m told that Lyme disease is a chronic condition and that they’re not obligated to treat it because it isn’t acute. I’ve been told I’m only qualified for the cheap treatment.”

Bruzzese said that Mercy is not a primary care provider and that often makes the emergency room the only option for people like Deile. “We don’t employ primary care physicians, so for most people who can’t afford primary care, the emergency room becomes their last option,” he said.

Still, Bruzzese said that Mercy and its employees deserve credit for the service they provide to those in need. “It’s not only Mercy as an organization that supports the community, it’s the care providers that make sacrifices and help people heal and repair their bodies and improve their well being and condition in life,” he said.

Although Gamble wholeheartedly agreed that Mercy is providing an invaluable service to the community at large, he said that more is needed. One cooperative step between the VOA and Mercy that has been successful is the Community Shelter’s “Medical Respite Bed” program, he said. Over the years, the shelter has helped homeless people with everything from broken bones to Lou Gehrig’s disease recover. In 2002, the program saw more than 500 user nights. Last year, it had more than 250 nights.

“Mercy realistically can’t discharge a seriously ill person into a situation where there is not care,” Gamble said noting that the “Medical Respite Bed” helps fill that void.

“It costs us about $25 a night to have someone in that bed,” Gamble continued. “I don’t think anyone can get out of the door of the hospital for less than $1,000 a night. With this bed, we’ve been able to save enormous amounts of money for the community. It’s been a very successful partnership.”

As a further solution to the problem, DeGuelle said it would be nice to see the return of a community clinic to Durango. “I think a community clinic that was on a straight sliding scale would be very beneficial for everyone here,” she said.

And Gamble said that primary care providers could also help lend a hand to local people in need. “We realize that you can’t go to the well too often,” he said. “But if a medical office could see one person a month or some other modest level of commitment, that could help to address the problem.”

Still, more global solutions are required not just for the homeless but for everyone who struggles with the expense of health care, said Gamble. “The final sad commentary is that the wealthiest nation in the country spends more than any other country in the world on health care and yet we have the worst access to health care,” he said. “There is something evidently wrong with this picture.”

As evidence, Deile said he is seeing his search for health care go nowhere. He considered travelling to the East Coast in hopes of finding the remedy, but travel is becoming harder. Instead he is resolving to accept the worst-case scenario. “It’s gone on so long,” he concluded. “It seems like it’s the reality that treatment is not going to be available.”






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