Reach homeless with mobile clinics

Costs tied to medical care for the state’s homeless are large and growing. Emergency room treatment for a festering staph infection or various minor injuries that worsen on the street can easily add up to a pricey hospital bill.

That’s why a Senate bill proposing mobile clinics to treat some ailing and injured homeless individuals makes good sense. Senate Bill 347 calls for the state to spend $1.4 million every year to operate two rolling clinics that would tend to homeless patients contending with non-life-threatening issues and thereby help trim emergency room costs.

In written testimony supporting the bill, Paula Yoshioka, a senior vice president at The Queen’s Health Systems, said it “recognizes the great cost that many health care providers take on to care for this vulnerable and underserved population.”

She pointed out that during the 2015 fiscal year, for example, Queen’s hospitals tallied 10,459 “encounters” involving care for homeless individuals. (All other facilities statewide recorded a total of 5,381 encounters.) And upwards of 90 percent of the Queen’s care took place in emergency rooms. Yoshida said Queen’s attributes a net loss of $10.6 million in that fiscal year to unfunded and underfunded care for homeless patients.

For the sake of both preventive health care and lowering medical costs, state lawmakers should support the proposal, which estimates the price tag to purchase and outfit each vehicle at $500,000. State Sen. Josh Green (D, Kona-Kau) envisions the mobile clinics operating primarily on Oahu, with periodic trips to the neighbor islands to tend to homeless medical needs there. An emergency room physician himself, Green would like to see each of van staffed with a driver, doctor, nurse and psychiatrist.

Coincidentally, the proposal is taking shape as a state contract that had funded mobile clinic services in the Waikiki area ended this week. The state is now contracted with the Institute for Human Services for homeless services in the region previously covered by Waikiki Health and its Care-A-Van vehicles. However, IHS has no similar mobile clinic.

Care-A-Van vehicles, which stopped rolling as homeless-outreach clinics on Tuesday, will now be used at the Next Step shelter in Kakaako for other purposes. Also, the nonprofit’s Care-A-Van two-story Kaimuki clinic continues to offer medical, behavioral and social services for homeless clients. Waikiki Health CEO Sheila Beckham, meanwhile, applauds the Senate bill’s aim to “help our homeless with access to medical care.”

The state Department of Human Services, which contracts homeless outreach services with providers, and the state’s coordinator on homelessness, Scott Morishige, have submitted testimony expressing concerns that funding allocated for mobile medical clinics could threaten funding for Gov. David Ige’s plans to address the state’s overall homeless problem.

Morishige asked legislators to support the governor’s executive budget request for homeless services, “particularly $1.5 million in additional funding for homeless outreach; $1 million for homeless individuals with serious and persistent mental health challenges; and $800,000 for outreach and counseling services for chronically homeless persons with severe substance use disorders.”

Although IHS does not have a clinic on wheels, Morishige said, its homeless outreach team includes a nurse and a psychiatrist to address medical needs.

“Outreach is about more than just medical care, and is essential to meet unsheltered homeless households in the community and to build rapport that connects them to housing and services,” he said.

That’s true. Over the next few months, as legislators weigh funding priorities, they should take a careful look at all proposals that address problems linked to homelessness. Nonetheless, by addressing a serious treatment gap and reducing health care costs, mobile medical clinics can be an efficient, effective investment that saves money in the long run.