[Hpn] Homeless need an infirmary, workers claim

Graeme Bacque gbacque@idirect.com
Sun, 04 Jun 2000 04:51:58 -0400


June 4, 2000 		

Cheap care ahead for street people?
Homeless need an infirmary, workers claim

By Jack Lakey
Toronto Star City Hall Bureau

Toronto's homeless, who are being kicked out of hospital long before they 
are well enough to return to the street, need a place to recuperate, say 
doctors and nurses who treat them.

``I have come to realize we need infirmary care for homeless people,'' says 
Kathy Hardill, a street nurse with the Regent Park Community Health Centre.

``People who are homeless are so much sicker now, they have so much more 
chronic illness and infectious diseases. And with the perpetual shortage of 
hostel beds, I can't get them into shelters.''

Dr. Thomaslav Svoboda, who works at the Seaton House men's hostel, studied 
the relationship between homelessness and health care as part of a doctoral 
thesis.

His preliminary research points to the conclusion that homeless people are 
more expensive to the health care system than others, partly because they 
don't have a chance to recuperate properly.

``The system is set up for you and me, not for somebody living on the 
street or in a hostel,'' Svoboda said.

``A doctor gives you a sheet with some garbled instructions at the bottom 
about your medication, a phone number and an appointment in two weeks.

``But what if you lose the piece of paper, or you don't read English very 
well, or it gets rained on, or you don't have a quarter for a phone, or you 
get beat up, or you just forget?

``It probably means you don't get the treatment you're supposed to, and 
that could mean you don't recover.

``If you're still sick, you end up back at the emergency room sooner or 
later, and what does that cost?''

Svoboda stressed that ``we're at a frontier point'' in medical treatment 
for the homeless.

``We have to try new things if we really want to help people.''

In the early '90s, a large Boston hospital examined what it cost Medicaid, 
the U.S. public health insurer, to treat homeless people.

The study found a homeless person's average length of stay in hospital was 
17 days, while the average for other patients was about five days.

The cost per day for a hospital bed for a homeless person was about $1,600, 
compared with just $600 for people who were covered by Medicaid but had a 
home.

But an Ontario Ministry of Health spokesperson says the province hasn't 
studied the correlation between homelessness and health-care costs.

Bob Taube, executive director of McInnis House, a unique, 80-bed facility 
that provides recuperative care for Boston's homeless, said a similar 
operation on a smaller scale could easily be set up in other cities.

``I'd think that for $500,000 to $1 million (U.S.), you could get something 
like what we're doing up and running, on a limited scale,'' said Taube, 
adding that staffing costs would be extra.

So far, Hardill says, she has seen nothing to suggest the province would be 
interested in a creative means of helping the homeless get well, even if it 
was cheaper in the long run.

``If we could provide some intermediate-level care, we might be able to 
prevent unnecessary returns to the emergency room and readmissions,'' said 
Dr. Stephen Hwang, who works at St. Michael's Hospital.

``We could shorten the level of a homeless person's stay by providing a 
site where we were confident we could send them safely, and that they'd get 
the care they need.''

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