Healthcare for the Homeless

ANNUAL HEALTHCARE NEEDS ASSESSMENT 2002

SUMMARY

In August and September 2001, interviews were conducted with 117 homeless persons at 13 homeless service sites in Houston to assess their health care needs. The interviewers were 10 medical students from Baylor College of Medicine and The University of Texas-Houston Medical School and one student from The University of Texas School of Public Health. The summary below includes data on 104 respondents, who had been homeless for 3 months or longer during the previous 12 months.

The ages of the respondents ranged from 18 through 80, with an average age of 42. The proportion of males in the sample was 53.8%. African-Americans/Blacks represented 58.4% and Whites 32.7% of the participants. Some college education had been received by 37.9% of the respondents and an additional third were high school graduates. The percentage of the participants who were working full-time or part-time was 28.7%; there were a few temporary workers and day laborers. .

During the previous 12 months, about half the respondents (51.9%) had been homeless the whole time, 13.5% for 9-11 months, 19.2% for 6 to 8 months and 15.4% for 3 to 5 months. Thirteen persons had a total amount of homelessness of 10 years or longer and the same number for a total period of 5 years to 9 years, 11 months; 47.6% had been homeless for one year to 4 years 11 months, and 27.2% for less than a year..

All but 9 respondents had received some health care during the previous 12 months. The majority of them (79.8%) reported having a regular source of care. For over a third of them, this source was an emergency room, with hospital outpatient departments/clinics and Harris County Hospital District clinics being the regular sources of care for 25.1% and 21.7% of respondents, respectively.

The number of visits to regular sources of care during the previous 12 months ranged from 0 to 59, with a mean of 8 visits. Nearly two-thirds of the respondents with a regular source of care had received care from at least one other facility. Thirteen persons without a regular source of care had made at least one health care visit during the previous 12 months. At least one emergency room visit had been made by 38.5% of the respondents. About a third of the participants had been hospitalized during the previous 12 months.

A current gold card was held by 35.6% of the homeless persons, including 43.4% of those with a regular source of care. A fifth of the respondents were covered by Medicaid and/or Medicare. Almost a third of the homeless persons reported needing medical care but unable to get it at some time during the previous 12 months.

TB skin tests and HIV tests had been received by 46.1% of the sample during the previous year, and 28.8% had received treatment for alcohol and/or drug problems.

A third of the respondents assessed their health as better that that of other people of their age, 28.2% as about the same, 19.4% as worse, 13.6% as much worse, and 5.8% as much better. Just over half of the participants (52.0%) reported that their health prevented them from working and 54.8% that it limited their daily activities.

OBJECTIVE

To identify the health care needs of homeless persons in Houston

BACKGROUND

Healthcare for the Homeless-Houston (HHH) is a consortium of health care and other providers of services for the homeless. Each year, HHH prepares a strategic plan to guide the development of needed changes in services. Goals are identified for improving access to and quality of care.

The annual strategic plan is now guided by:

Annual needs assessment
Demand for services
HHH Advisory Council and clinicians
Expert committee of homeless consumers

Examples of changes identified by previous needs assessment include:

A Women and Children's Clinic for the Homeless at Lord of the Streets
Shelter outreach in the evenings
Clinic hours on the weekend
Electronic Medical Records
Transportation project to reduce a major barrier to care

METHODS

l In August and September 2001, 117 interviews were conducted at 14 sites by 11
medical students from Baylor College of Medicine and The University of Texas -
Houston Medical School and 1 student from The University of Texas School of
Public Health - Houston.

Sites Surveyed

Brigid's Hope
Compass
DeGeorge at Union Station (SRO Housing)
Harmony House
HOMES Clinic
Houston Area Women's Center
Montrose Clinic

Open Door Mission
Palmer Way Station
Sally's House-Salvation Army
SEARCH-Outreach
SEARCH-Resource Center
Star of Hope Men's Development Center
The Women's Home

At each site, interviews were conducted with all eligible homeless people willing to
participate.
Eligible participants were homeless persons aged 18 and older, who were able to
speak and understand English. The homeless criterion was to have spent most of
the previous month in shelters, on the streets, in transitional housing, and/or at the
home of a friend or family member.
Participants were not asked for their names and were assured of the
confidentiality of their responses.

THE SURVEY INSTRUMENT

The interview schedule addressed the following topics:
- Utilization of health services
- Health and functional status
- Respondents' perspectives on health care and health
- Homelessness and demographic characteristics
Most of the questions were closed but open-ended questions were used in the
"perspectives" section. The interviews took an average of 17 minutes to
complete.
Some of the questions in the first section had been used in the previous year's needs
assessment; the first 2 questions were used in the UCLA/RAND Homeless Women's
Health Project.

RESULTS

Length of time homeless during the previous 12 months

105 respondents had been homeless for 3 months or longer during the
previous 12 months and are included in these analyses.
About half the participants (n=55) had been homeless for the whole year;
14 participants had been homeless for 9-11 months, 20 for 6 to 8 months, and
16 for 3 to 5 months.

Demographics

Gender: 55.2% male
Age: Average = 41; (range: 18 - 80)
Marital status: nearly half single; 26.9% divorced; 19.2% were separated. Only
2 were married and 3 widowed.
Race/ethnicity: African-Americans/Blacks represented 58.4% of the
respondents, and Whites 32.7%; only 6 Hispanics participated.
Education: Two-thirds graduated from high school or GED (1/3 with some
college education); only 2 had had only a grade school education.
Work: 29% of the respondents were working, about one-third of whom were
working full-time
Veterans: about a quarter of the participants were veterans.

Health care utilization during the previous 12 months

34% (36/105) of the participants had a current Hospital District gold card;
29% (20/69) without gold cards had tried to obtain a card.
37% (36/96) identify the ER as their "regular" source of care.
- 68% (21/31) of those for whom the ER was the "regular' source of care
  did not have a current Harris County gold card.
  - 33% (6/18) of them had tried to get a gold card.
l 31% (33/103) participants reported needing medical care but unable to get it at
some time during the previous 12 months.
- Barriers included
  - lack of a gold card or insurance
  - cost of care
  - lack of transportation
  - long waits for care or an appointment
  - "red tape"
35% (34/96) hospitalized (number of days ranged from 1 to 60).
29% (30/105) had received treatment for alcohol or drug abuse; 12% (13/105)
would have liked such treatment.
The number of visits made to the regular sources of care ranged from 0 (n=3)
to 50.

HEALTH STATUS

52% (53/102) reported that their health prevented them from working
55% (57/104) said their health limited their daily activities

HEALTH BEHAVIORS

63%(66/105) of the participants had received a TB skin test and 81%(85/105) had
received an HIV test during the previous 2 years.
91% (95/104) were trying to improve their health in some way.
Examples include:
- nutrition-related actions (the most frequently cited)
- exercise
- taking medications
- reduction of health risks (e.g.- tobacco and alcohol reduction or cessation)
- adequate sleep
- meditation

LIMITATION

Data may not be generalizeable to Houston's entire homeless population

FUTURE DIRECTIONS

Refine sampling methods to enhance generalizeability
Identify factors associated with use of the emergency room and develop areas for
related interventions to increase primary care utilization
Complete analysis of data
Explore why the homeless identify the ER as their "regular" source of care
Explore what "regular" source of care means to the homeless
Identify interventions that may increase primary care utilization and decrease ER
utilization

Participating agencies include:� 1414 Congress, AIDS Foundation � Houston, Bread of Life, Bridget�s Hope, Compass, DeGeorge Hotel, Harmony House, Open Door Mission, Palmer Way Station, Salvation Army � Harbor Lights, SEARCH Mobile Outreach Program, SEARCH Resource Center, Shalom Zone Health Ministries, Star of Hope Men�s Development Center, and Star of Hope Transitional Living Center

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David S. Buck, M.D., M.P.H.
President and Chief Medical Officer
P.O. Box 66690
Houston, TX 77266
TEL: (713) 798-6067
FAX: (713) 759-1502

dbuck@bcm.tmc.edu

Frances Isbell, M.A.
Executive Director
P.O. Box 66690
Houston, TX 77266
TEL: (713) 798-6067
FAX: (713) 759-1502
fisbell@bcm.tmc.edu

� 1995-2001 Homeless Healthcare-Houston
URL: http://www.homeless-healthcare.org
Modified: Spring 2002
Please contact Regina Knight-Richie, RKnight@bcm.tmc.edu, for more information