Homeless Health

Dr. Dave Deci examines a patient at a medical clinic at Grace Episcopal Church in Madison as part of an effort to provide healthcare to the homeless in this 2011 file photo.

In Madison, home to one of the nation’s acclaimed health care systems, the homeless can needlessly suffer.

Some don’t get care until illness or dental needs become acute. Mothers with newborns and those recovering from surgery can be discharged to the streets. The terminally ill may have no place to die with dignity.

Many need mental health or substance abuse treatment. Others suffer from untreated diabetes, heart disease, infections, foot or dental problems and are unable to get medications. Some are diagnosed too late to be helped or lack insurance. Transportation is a challenge. A lack of cellphones or minutes on them can undermine scheduling appointments, and getting lab results and instruction.

In late 2009, with support from the Meriter Foundation, a street medicine program called Helping Educate and Link the Homeless (HEALTH), was started to help overcome barriers and navigate complexities of the system. The Madison Dental Initiative, founded the same year, serves the homeless with on-site dental care at the Salvation Army of Dane County family shelter on the Near East Side.

But more is needed, with gaps in transportation and communication alone resulting in higher emergency room use and longer hospital stays because there’s no safe discharge plan, said Matthew Julian, social worker for HEALTH.

“Systems should be built that allow for the particular needs of those thought of as vulnerable,” said Dr. Ann Catlett, internist and palliative medicine specialist at UW Health and part of a group called MACH OneHealth formed last fall to provide care to people with insecure housing.

MACH OneHealth has already launched a community health needs assessment and primary care foot clinic.

For respite, Madison-area Urban Ministries is fundraising to create the eight- to 10-bed Healing House for homeless families with a member in need of recuperative care. It would be the first in the state.

Linda Ketcham, executive director at MUM, said 70 to 90 pregnant women are homeless each year, and that they and their newborns sometimes have no place to go after hospital discharge. Overall, the medical system inadequately tracks homeless patients, which affects discharge planning, and the homeless delay medical procedures because there’s no place to recuperate, she said.

Healing House would provide respite with three meals a day, case management, transportation and more, Ketcham said. It would work with an estimated 48 to 60 patients annually.

MUM is seeking $150,000 for operations from each of the city’s three hospitals for each of the first three years. The $150 per bed per day cost pales compared to hospital costs, Ketcham said. Once Healing House is running, MUM will explore options to provide respite for homeless adults.

Another group called A Welcome Home is hoping to create a hospice care facility for the homeless. The intent is to secure a centrally located home to provide several months of care — perhaps for free — for up to four people at a time, with an estimated need of caring for 15 to 20 people each year.

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Dean Mosiman covers Madison city government for the Wisconsin State Journal.