Our new fact sheet “Health Care of Homeless Individuals Fact Sheet – 2016” reports the current state of diagnosis and treatment of homeless patients for twelve chronic and other life-threatening or serious health conditions to assess whether homeless patients are receiving prompt and life-saving diagnosis or treatment and to determine what improvements are needed to ensure that they are able to receive such diagnosis and treatment.
Our fact sheet reports data from Federally Qualified Health Centers (“Health Centers”) and Health Care for the Homeless Program Grantee Health Centers (“HCH Health Centers”). Health Centers and HCH Health Centers serve a critical role in providing health care for homeless individuals and other low-income individuals. During 2014, 1.15 million homeless people among 22.9 million people were seen at Health Centers, including 813,000 homeless people at HCH Health Centers, for medical care, dental care, and other health care. In 2015, the number of homeless patients and total patients increased with 1.19 million homeless people among 24.3 million people seen at Health Centers, including 840,000 homeless people at HCH Health Centers. In 2016, the number of homeless patients and total patients increased again with 1.26 million homeless people among 25.8 million people seen at Health Centers, including 886,576 homeless people at HCH Health Centers.
Without Health Centers and HCH Health Centers, millions of homeless and low-income people may not have any way to seek treatment for these chronic and serious health conditions before they become acute emergencies and possibly too late for life-saving treatment because a majority of them have little income and many of them have no health insurance. At Health Centers, 71% of the patients had income below the federal poverty level and 28% were uninsured in 2014, 71% of the patients had income below the federal poverty level and 24% were uninsured in 2015, and 70% of the patients had income below the federal poverty level and 23% were uninsured in 2016. These percent values are even higher for homeless patients. At HCH Health Centers, when homeless patients constituted 95% of the total patients in 2014, 89% of the patients had income below the federal poverty level and 43% were uninsured, when homeless patients constituted 94% of the total patients in 2015, 88% of the patients had income below the federal poverty level and 38% were uninsured, and when homeless patients constituted 95% of the total patients in 2016, 85% of the patients had income below the federal poverty level and 36% were uninsured.
At Health Centers, a total of 6.3 million patients were uninsured in 2014, a total of 5.9 million patients were uninsured in 2015, and a total of 6.1 million patients were uninsured in 2016. At HCH Health Centers, 368,000 patients were uninsured in 2014, 334,000 patients were uninsured in 2015, and 335,000 patients were uninsured in 2016.
Hundreds of thousands of homeless patients were unable to or did not receive diagnosis at Health Centers and HCH Health Centers. Among the low screening levels for life-threatening or serious health conditions were low screening levels for cancer and for Hepatitis B and Hepatitis C, which causes liver disease and lead to death. For example, only 15% and 16% of female patients aged 50 to 74 received a mammogram at HCH Health Centers and at all Health Centers in 2016, similar to the previous two years, only 54% to 565 of female patients aged 24 through 64 at all Health Centers had cervical cancer screening in the past three years as recommended, and only 39% of adults aged 50 to 74 received appropriate colorectal cancer screening at all Health Centers in 2016, slightly higher than in 2014 and 2015. Also, only 5% and 4% of patients aged 18 through 64 at HCH Health Centers and at all Health Centers were tested for Hepatitis B and only 8% and 4% of patients aged 18 through 64 at HCH Health Centers and at all Health Centers were tested for Hepatitis C in 2016, slightly higher than in 2014 and 2015.
Although the Health Center data do not report treatment levels for each life-threatening or serious health condition, the reported treatment data for HIV/AIDS, diabetes, and asthma treatment are below recommended levels. Although it is recommended that 85% of patients with HIV or AIDS receive prompt access to care within 90 days of diagnosis, the HIV Linkage to Care at Health Centers was only 83% in 2016, moderately higher than in 2014 and 2015. Likewise, although it is recommended that only 16.2% of adults diagnosed with diabetes have an HbA1c > 9, 32% of adult patients aged 18 to 75 at all Health Centers had an HbA1c value above this level or no test result in 2016, similar to 2014 and 2015. In addition, although it is recommended that only 49 persons per 10,000 persons aged 5 through 64 visit an emergency department for asthma-related reasons, 47,000 patients with persistent asthma aged 5 through 64 were not prescribed appropriate medication therapy at all Health Centers in 2016, similar to, albeit somewhat less than, the 74,000 and 52,000 patients not prescribed appropriate medication in the previous two years.
Likewise, deaths of homeless individuals for other health conditions suggest they did not receive treatment. For example, 12 homeless individuals died from tuberculosis in 2014, 10 homeless individuals died from tuberculosis in 2015, and 5 homeless individuals died from tuberculosis in 2016 and dozens of homeless individuals are reported to have died from hypothermia, hyperthermia, and exposure to cold or heat in 2014, 2015, and 2016.
In addition, hundreds of thousands of homeless patients likely did not receive critical preventative and treatment dental care to prevent and treat painful and potentially life-threatening tooth decay and periodontal disease at HCH Health Centers and at all Health Centers. Although it is recommended that 49% of children and adults use the dental care system each year, only 12% of patients at HCH Health Centers and 18% of patients at all Health Centers had an oral exam and only 5% of patients at HCH Health Centers and 11% of patients at all Health Centers received prophylaxis in 2016, slightly higher than in 2014 and 2015. Although 25% of Americans have untreated dental decay, less than 1% of all patients at HCH Health Centers and less than 2% of patients at all Health Centers receive sealants, only 3% of patients at HCH Health Centers and 8% of patients at all Health Centers received fluoride treatment, only 4% of patients at all HCH Health Centers and 7% of patients at all Health Centers received restorative services, only 4% of patients at HCH Health Centers and 4% of patients at all Health Centers received oral surgery, and less than1% of patients at HCH Health Centers and less than 1% of patients at all Health Centers obtained emergency dental services in 2016. Although 47% of adults aged 45 to 74 have moderate or severe periodontitis, only 8% and 10% of patients aged 45 to 74 at HCH Health Centers and at all Health Centers received rehabilitative services in 2016, slightly higher than in 2014 and 2015.
In addition, hundreds of thousands of homeless patients likely did not receive critical preventative and treatment vision care to prevent, diagnose, and treat the life-altering and life-threatening eye diseases of glaucoma, diabetic retinopathy, and age-related macular degeneration at HCH Health Centers and at all Health Centers. Although it is recommended that 60.5% of adults have a comprehensive eye exam, including dilation, within the past two years, less than 3% of adults aged 18 and older received a comprehensive or intermediate eye exam at HCH Health Centers and at all Health Centers in 2016, similar to 2014 and 2015.
When the risk of death and other serious health consequences can be reduced with preventative care, diagnosis, and treatment for cancer and other life-threatening diseases, such as HIV/AIDS, Hepatitis B and C, cardiovascular disease, diabetes, asthma, hypothermia, frostbite, heat stroke and health exhaustion, tooth decay and periodontal disease, and eye diseases, all Americans, including all homeless persons, should have access to preventative care, diagnostic tests, and treatment through expanded access to shelter and supportive housing, health insurance, and increased funding for Health Centers and HCH Health Centers.
