Our new fact sheet “Health Care of Homeless Individuals Fact Sheet – 2015” 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. These numbers increased in 2015, with 1.19 million homeless people among 24.3 million people seen at Health Centers, including 840,000 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. At Health Centers, 71.2% of the patients had income below the federal poverty level and 27.9% were uninsured in 2014 and 70.9% of the patients had income below the federal poverty level and 24.4% were uninsured in 2015. These percent values are even higher for homeless patients. At HCH Health Centers, when homeless patients constituted 95.3% of the total patients in 2014, 88.9% of the patients had income below the federal poverty level and 43.1% were uninsured, and when homeless patients constituted 94.4% of the total patients in 2015, 87.8% of the patients had income below the federal poverty level and 37.6% were uninsured.
At Health Centers, a total of 6.3 million patients were uninsured in 2014 and a total of 5.9 million patients were uninsured in 2015. At HCH Health Centers, 368,000 patients were uninsured in 2014 and 334,000 patients were uninsured in 2015.
Hundreds of thousands of homeless patients were unable to or did not receive diagnosis and/or treatment 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 cause liver disease and lead to death. For example, only 16% of female patients ages 50 to 74 received a mammogram in 2014 and 2015 at HCH Health Centers and at all Health Centers, only 56% of female patients ages 24 through 64 at all Health Centers had cervical cancer screening in the past three years as recommended and only 34% and 38% of adults ages 50 to 74 received appropriate colorectal cancer screening at all Health Centers in 2014 and 2015. Also, less than 5% of patients ages 18 through 64 at HCH Health Centers and at all Health Centers were tested for Hepatitis B and less than 7% of patients ages 18 through 64 at HCH Health Centers and at all Health Centers were tested for Hepatitis C 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 and diabetes 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 Linkage to Care at Health Centers was only 77% in 2014 and 75% in 2015. Likewise, although it is recommended that 83.8% of adults diagnosed with diabetes have an HbA1c ≤ 9, only 68.8% of adult patients age 18 to 75 at Health Centers in 2014 and 56.8% of adult patients age 18 to 75 at Health Centers in 2015 had an HbA1C value below this level.
Likewise, deaths of homeless individuals for other health conditions suggest they did not receive treatment. For example, 7 homeless individuals died from tuberculosis in 2013 and dozens of homeless individuals are reported to have died from hypothermia, hyperthermia, and exposure to cold or heat in 2014 and 2015.
When the risk of death and other serious health consequences can be reduced with diagnosis and treatment for cancer and other life-threatening diseases such as HIV/AIDS, Hepatitis B and C, cardiovascular disease, diabetes, asthma, hypothermia, frostbite, and heat stroke and heat exhaustion, tooth decay and periodontal disease, and eye diseases, all Americans, including all homeless persons, should have access to diagnostic tests and treatment through either expanded access to shelter and supportive housing, health insurance, and/or increased funding for Health Centers and HCH Health Centers.