Rehumanizing Healthcare for Homeless Populations

Health care access

Expand existing project, program, or initiative (expanding and continuing ongoing, successful work)

LA’s public health agencies are siloed. Too often, the Dept. of Health doesn’t talk to the Dept. of Mental Health, who doesn’t talk to Corrections, who doesn’t talk to social workers. They have mutual challenges and address the same community needs, but rarely work together. Likewise, practitioners operate in disciplinary siloes. An MD addressing a patient’s medical needs is in the dark about their mental health history, and vice versa.
In our bureaucratic world of healthcare people are reduced to numbers, a patient is the only one with the full picture, and the onus is on them to coordinate their care. This is difficult for anyone and a disaster for our homeless community. Many don’t have wifi or a smart phone. Most are so traumatized by their experience, they have lost all trust in institutions’ ability to help them. Others, battling addition or mental health issues, simply don’t have the mental capacity to understand, let alone communicate their healthcare needs or unravel red tape.

The Covid crisis created an inadvertent experiment and unintended success story. The public health risk inspired LA’s 3 health departments to set up Quarantine and Isolation (QI) medical shelters, run by multidisciplinary teams for homeless Covid patients with no safe place to quarantine. In this state of emergency, frontline workers were suddenly freed from the bureaucratic constraints. Space was was made for innovation and discoveries about a new model that worked; Over 2 years, 13,000+ people were treated at the QIs. There was only 1 death, countless cases of dramatic improvements in patients’ overall health, and a high rate of housing placements. Since 2022 LAPD has been interviewing QI staff and Skid Row community members who led mutual aid efforts. This research inspired our “Welcome to the Covid Hotel” exhibition, theatrical performances and public conversations that are engaging audiences with the lessons learned. This work has gained momentum. We have built a network of stakeholders with a shared vision, passion, and consensus around fixing the system that is failing our most vulnerable citizens.
Project activities launch an advocacy campaign for Respite Centers to scale this rehumanized healthcare model: 1) conclude research; 2) expand audience engagement with new performances, public discussions, and exhibition walk-throughs; 3) facilitate working group meetings to develop and launch an advocacy strategy; and 4) create and disseminate advocacy tools.

We envision Respite Centers county-wide, whose mandate is: get our most vulnerable people off the streets, give them personalized care, and find them housing. The sites will operationalize key QI and grassroots approaches: Staff doctors, nurses, mental health clinicians and social workers will function as a team, talking daily to share information and their respective expertise, coming to understand the whole person to coordinate the best treatment plan and housing that “sticks.” With a housing-first policy, those with addition or mental health issues will be treated, not judged. Harm reduction practices will ensure people battling addiction are encouraged to remain. Building trust will be paramount; trauma-informed care and an abiding ethos of compassion will guide decision making. At the moment, we are unsure exactly where our advocacy will take us, but we know where we want to end up: with a place where our homeless community feels the healthcare industry actually cares for them.

QI data: 93% of the patients who needed housing were housed. Staff came to believe “it is possible to end homelessness in a very reasonable, measurable amount of time.” There were countless cases of people whose overall health improved significantly because they were encouraged to address long-ignored chronic issues. One man came in blind and got cataract surgeries that restored his sight. “Covid Hotel” has engaged 300+ people including stakeholders, policy makers, and County public health leaders: Hilda Solis’s homelessness Deputy; Adam Schiff’s homelessness policy advisors; Molly Rysman, Housing for Health Dir of Policy and Planning; Heidi Behforouz, Senior Physician at Dept. of Health Services; as well as scholars and students (UCLA, UC Riverside UNLV, Stanford) etc. We will track attendance, press coverage, and our success shifting public opinion, galvanizing dialogue, and engaging those in a position to muster the political will and resources needed to realize our vision.