Medical professionals have long considered homelessness a public health matter and a new state law has put doctors on the front lines of managing the issue. Hundreds of physicians are now offering their perspective to improve policies that aid the state's large unsheltered population.
The California Medical Association focused on the health needs of the homeless population and its impact on the greater community during its annual policy meeting last week. Attendees reviewed research and discussed recommendations that will drive the organization's 2020 legislative lobbying efforts.
Ted Mazer, a San Diego doctor and former state association president, said the group's 500 delegates are working to better guide public policy and investment.
“We're trying to focus to actually say 'these are the things that we believe you can focus the expenditure on, be efficient in doing that and stop the cycle of homelessness,’” Mazer said.
He said laws designed to assist the homeless community, however well-intentioned, can at times cause more challenges for doctors. Mazer specifically pointed to a newly implemented law that requires hospitals to provide additional services to homeless patients before they’re discharged.
The law that went into effect this year mandates hospitals find a post-care location, such as a shelter or relative's home, and provide food, clothing and arrange transportation if it's within 30 miles or minutes. The new requirements prevent hospitals from discharging or "dumping" patients who don't have a safe place to go after receiving treatment.
Mazer said medical professionals at the meeting spoke of overcrowded emergency rooms because they were unable to place homeless patients in locations that could support their needs.
"The emergency rooms are now sheltering (homeless individuals), blocking other patients coming in," Mazer said.
UC Davis Health CEO Dr. David Lubarsky, who presented at the meeting, said homeless patients shouldn't be discharged to the streets, but finding a post-care location is difficult because many facilities won't provide even minimal recovery services, such as changing a wound dressing.
"Even if they only need 20 minutes of health care every other day, they remain in the hospital for a month because there's no shelter that will do that," Lubarsky said in a phone interview.
The patients may not be able to take care of themselves because they lack the resources, such as transportation and money, to acquire the materials they need, and therefore cannot be discharged, he said.
California Medical Association opposed the bill, which was sponsored by the California Pan-Ethnic Health Network or CPEHN.
CPEHN Executive Director Kiran Savage-Sangwan said the post-hospital location is largely influenced by the patient.
"A patient’s residence is broadly defined and does not have to be a sheltered location. It can be any place the patient says they live or would like to go, like a tent," Savage-Sangwan said in an email. "The law was passed in response to hospitals having patients transported far away from any familiar place."
Lubarksy and Mazer said in order to prevent discharged homeless patients from landing back on the streets, a system is needed that combines adequate follow-up care with long-term services.
The California Medical Association is still finalizing the language of the policies its delegates approved, but recommendations focused on linking health and social services and on housing affordability, according to an Oct. 29 statement on the organization's website.
The attending physicians also discussed augmented intelligence, cannabis and adverse childhood experiences.
