The problem of homelessness in Madison has been front and center in the last year. The city has twice removed homeless encampments from sites on East Washington Avenue and Mayor Paul Soglin has drawn fire from some for suggesting the homeless be bused out of the city.
Meanwhile, Dane County officials are proposing the former Lussier center on East Washington Avenue for a temporary warming shelter and hope to build a permanent daytime shelter in the coming years.
Meriter physician Cate Ranheim has a unique perspective on Madison's homeless through her work with the Helping Educate and Link the Homeless, or HEALTH, program, which she and her husband, also a physician, founded in 2009. It brings medical care and other services to the homeless population.
Q: How did you get interested in this work?
A: My husband, Erik, and I, and our four children have participated in international health missions that led us to recognize that we could and should be giving back more in our community as physicians. As a hospitalist at Meriter, I frequently saw people who were homeless readmitted to the hospital extremely ill because they had been previously discharged from the hospital or ER to the street or shelters with instructions they couldn't read or understand, with prescriptions they didn't have the money to fill and with advice to follow up with primary care physicians they didn't have. I was guilty of this myself as a doctor because I didn't know what else to do, and I recognized that there had to be a better way.
Q: Give me an idea of the scope of the HEALTH program.
A: As of today, 860 homeless patients are enrolled. About 40 volunteers participate in the program, including physicians, nurses, administrative staff, pharmacists, social workers and therapists, (and) we have a full-time employed nurse.
Q: Is the program working?
A: We demonstrated a decrease in inpatient charges at Meriter hospital of $800,000 among HEALTH patients when the program had enrolled 425 patients. We don't have access to the data from other hospitals in town but expect that this decrease has been experienced in other health care systems as well. We believe this decrease in inpatient costs was due to better overall health in the homeless population by ongoing access to a unique health care approach called "street medicine." This consists of customized delivery of ongoing health care and case management on the street, or wherever people who are homeless find shelter or receive other services.
Q: Are you seeing more patients than when you started the program?
A: Yes, our numbers have grown substantially — to the point where we have had to restrict access due to limited resources.
Q: What are the most common health needs among the chronically homeless?
A: Uncontrolled diabetes, heart disease, high blood pressure and infections, particularly related to foot ulcers. A high percentage also have substance abuse problems and mental illness.