January 2024 blog

No Place to Rest or Recover

Without respite care chronically homeless die 30 years early 

By Lynn Swan, MD

 

As a TC Street Medicine doctor, I see heartbreaking scenarios involving our fellow human beings who have no place to rest or recover after a hospitalization, surgery, or even common illnesses like COVID. 

 

Where can people experiencing homelessness go to rest and recover? Where can they recover from an infectious disease that puts others in a crowded living situation at risk of serious illness or death?  Where can our vulnerable, older people with COPD recover from serious bronchitis not requiring hospitalization?

 

What about outpatient surgeries? The average unsheltered person spends 3 extra days in the hospital costing thousands of dollars due to the complexities of a discharge for someone experiencing homelessness.  

 

Leg ulcers, burns, and wound care are frequent conditions seen in the field. Many people do not meet the criteria for hospital admission but are in risky circumstances to allow proper healing or even stabilization.  Most get worse. 

 

In the summer, people are in their cars or camping.  A patient had significant leg ulcers needing daily rewrapping.  Elevating the legs above the level of the heart is difficult in a car, complicating and lengthening the recovery.  Access to clean water for even simple bathing is difficult. The wounds are difficult to redress in a tent and it is almost impossible to maintain a sterile environment.  Heat often makes the wounds unbearably painful.  

 

In the wet spring/fall, complications arise because of the muddy conditions and soggy dressing.  A hot car or tent without air conditioning welcomes infection and non-healing, increasing the risk of amputations. In winter, the snow magnifies the deficiencies of old, ill-fitting boots. One patient was told to not walk at all while living in his car with feet propped up for months. 

 

Think about post orthopedic surgery recovery in a tent. Patients are often discharged on the same day because of a new change in the procedure.  We advocated for a middle-aged guest who needed hip surgery. The patient’s plan fell apart. Within a few days, the patient was back in the tent.  Watching him struggle to get in and out of a tent was unbearable as he tried not to bend the hip skin much less stand up and walk to Central Church.  We had a similar experience with a needed knee replacement.

 

The average person experiencing chronic homelessness will die 30 years early.  No one who serves this population feels okay about this statistic.  We care for our people! 

 

While housing is the ultimate solution, we should consider modifying the current shelters to accommodate acute illnesses or post- surgical recovery that doesn’t require hospitalization. A coalition supporting Medical Respite Care should be considered, which can provide a safe and healing environment that stabilizes health conditions. It could also provide care for those who are ready for discharge but are too frail to recover on the streets or in shelters.  Let’s provide a place to simply rest and recover.

 

Dr. Lynn Swan is the Medical Director of Safe Harbor and a practicing physician at Traverse Health Clinic and TC Street Medicine.