Want to Reduce Homelessness? Treat It Like Heart Disease

The difference between “cardiac arrest” and “heart attack” is a matter of time. Cardiac arrest happens at once – the whole heart stops beating. A heart attack takes years to come on, when a part of the cardiovascular system has a blockage and muscle begins to die. Heart disease often is a mixture of genes and choices. It can run in your family, but a steady diet of lots of junk food and little exercise play a part too. That’s why addressing heart disease involves a spectrum of approaches from prevention to CPR. You wouldn’t use the defibrillator on a person whose only symptom is high cholesterol.

Homelessness can be a chronic condition that operates much as heart disease does; the term doesn’t describe a universal experience. For example, the difference between “homelessness” and “chronic homelessness” is loosely comparable to that between heart attack and cardiac arrest.

Most people who are homeless are like those who are in cardiac arrest. They have had a “perfect storm” of bad luck (and maybe bad choices too). They were one or two paychecks from financial emergency to begin with. Then the sudden failure hit. They lost their job or someone they love, and then they started drinking again, and then they got behind on bills or had a relationship breakdown that forced them out of their home. They need a “jump start” (like a new job or family help) and with some time and healing they’ll be back on their feet.

People who are chronically homeless often are more like a heart attack. They almost always have a complex web of problems that stem from serious trauma they have survived that snowballed over a long time and is compounded by bad decisions along the way. Years of abuse, neglect, poverty, incarceration, addiction and mental/physical illness foster a steady deterioration of life. They are in crisis, but one “jump” will not revive them. In their case, they need a series of interventions with support and a care plan. Recovery will be a long, difficult road.

Emergency Shelters are like Emergency Rooms – they’re where you go in a crisis. The goal of both should be to get people stabilized, then move them to the individualized treatment they need (or back home) as fast as possible. Emergency Shelters, therefore, would do well to operate with the basic principles Emergency Rooms use.

Let’s return to the heart disease analogy. Three people with heart disease arrive at a hospital Emergency Room. One is unconscious and in cardiac arrest, one has chest pains and most likely is having a heart attack, and one is a little short of breath because he didn’t take his medicine for congestive heart failure today.

A strong, efficient Emergency Room handles this situation through triaging. The person in cardiac arrest is treated first with a defibrillator to get the heart started again. The person with the blocked artery is also immediately evaluated to see if open heart surgery or a balloon is needed. The person who didn’t take his pill may have to wait a while to be seen, but is examined. The nurse talks to him about why he didn’t take his medicine, and ensures he has the resources and knowledge needed to take it in the future.

Triaging allows the Emergency Room to deliver the appropriate resources in a manner that is the most effective and efficient approach – and most importantly, leads to the best outcomes for all patients.

If we take this loose analogy one step further, Emergency Shelter should be performing in the same way – effectively triaging people as they present with homelessness. But we’re not triaging right now and that’s one reason why we have such a high prevalence of chronic homelessness in Springfield. Those we should move through quickly we can’t, and those who need intensive intervention often don’t get that coordinated care.

As an agency that provides emergency shelter and housing to men and women experiencing homelessness in Springfield, Helping Hands knows we must do better as a community. We also know we play a role in improving our processes and outcomes.

One agency alone is not going to “solve” homelessness in Springfield, however. It requires a coordinated, cooperative response from a lot of people. Our part is to explore the role emergency shelter and housing play to improve the health of people in Springfield, educate others about the complexity of homelessness, and create ways we can all work together.