Local opinion: It's time to widen the lens on homelessness

Although I spent years working in healthcare and leadership, I wasn't prepared for what I witnessed working with the homeless.

Is increased homelessness the result of basic strategy failure?

Is this an elephant in the housing complex?

First impressions were stunning.

Countless people with physical disabilities and injuries. Neurologic symptoms mistaken for substance use. People recovering from chemotherapy or surgeries or prepping for colonoscopies in the park. Hospitals discharging people onto the street or in front of shelters unable to accept anyone not independent in activities of daily living. Worst of all, human beings who could clearly articulate the root cause of their own homelessness, but whom had never been asked; treated as part of an assumed homogeneous group; defined by the state of being unhoused.

Shortly after my psychiatrist dad died from dementia, I discovered an article he had co-written with an attorney friend in the early 1970s after deinstitutionalization. It forewarned of unintended inhumane consequences for people with severe mental illness released to live on the street but unable to care for themselves.

My passion for homelessness grew incrementally while directing patient experience departments at three academic medical hospitals, then leading an end-of-life care partnership, where I learned how many unhoused people were dying in pain.

Work on behalf of youth who had identified bereavement as trauma and primary cause of mental health issues, homelessness, and recidivism inspired me; led to a committee focused on homeless end-of-life care, followed by work on a new Medicaid initiative for health and housing.

The eurekas followed fast and furiously, but I was dumbfounded by the glaring glitches.

Could the central problem be obvious?

A massive public health issue was assigned to an agency with expertise in housing, not health.

Forty years after designation as lead agency on homelessness, HUD still mandates pages of redundant intake questions that prioritize where and for how long someone has been sleeping versus WHY they are homeless. Eviction is viewed as cause versus effect.

Accurate data regarding the current demographics of homelessness doesn’t exist.

We live in the Digital Age, yet analyses and data regarding homelessness are inconsistent, inaccurate, redundant, archaic and siloed. Federal funding via HUD is based on annual local “point in time” counts by volunteers trained to count homeless people they can see. Questions are created by the respective Continuum of Care, a longstanding HUD framework which, in practice, equates to regional hubs of non-profits desperate for funding, versus a true continuum of care.

There’s no person-centered, real-time, cross-specialty triage, critical for identifying primary/secondary needs and root causes.

The current situation would be akin to having hospital emergency department staff asking people in overcrowded waiting rooms who are “sick” to have a seat and wait for one-size-fits-all treatment without evaluation.

Research shows that homeless people die twenty years younger than the housed. Heart disease, cancer, diabetes, dementia, and other serious illnesses go undiagnosed, misdiagnosed, untreated, and exacerbated. People with mental health issues are lumped into a designation of SMI (Serious Mental Illness) that includes a range of diagnoses from depression and anxiety to psychotic disorders, making it hard to identify individual needs for support.

My dad died on a memory unit, the irony palpable for a man who had served as director of psychiatry for a huge public hospital, then found his resonance working with recently released prisoners. His seven marriages had left little money for me to manage his care as legal guardian, and as a result, my then husband and I, with two young daughters, were living on the brink, too.

I often think back to how fuzzy the plan was for me and my younger sister, as children aged 15 and 12, when our mom died after ignoring a lump in her breast out of financial worries. Like the discoveries about my dad, I later read an essay written by my mom, detailing the forsaken lives of children she served as a school social worker. I vividly remember those girls from visits to our home for meals and holidays, and the lines blurred between us and them.

‘Round and ‘round and we go ...