In Boston, we see them early in the morning, asleep in doorways, swathed head to toe in grimy blankets and plastic bags.
We see them on the sidewalks at all hours, shaking cups, asking for spare change.
When night comes on, we see them in small groups in alleyways and on stairs to the subway. They smoke cigarettes or joints, they argue vehemently about what seems nonsensical.
The Homeless.
We see them everywhere; seldom do we really look at them or think of them.
At such misery and desperation, it's hard to look squarely, and even harder to look at with an open heart and mind.
According to the U.S. Department of Housing and Urban Development, as of January 2019, Massachusetts had an estimated 18,471 persons who were experiencing homelessness on any given day. (The number is almost certainly higher now due to the economic damage wrought by the pandemic.)
Of that total, HUD said, 3,766 were families, that is, households without a house; 917 were military veterans, 480 were unaccompanied young adults ranging from 18 to 24 years of age, and 2,370 were individuals experiencing chronic homelessness.
For our homeless fellow Americans, living under constant stress and uncertainty, in unsanitary conditions, exposed to severe weather, is a recipe for bad health, premature aging, and early death.
The homeless are more likely to have HIV/AIDS, lung diseases, malnutrition, infected wounds, skin diseases, mental illness and addictions to alcohol and drugs.
According to researchers at the University of California at San Francisco, homeless persons in their 50s have more geriatric conditions than those who are decades older.
"Because of prolonged exposure to stress, those living in poverty often experience premature aging, also known as weathering," writes Liz Seegert in an article published by the Association of Health Care Journalists. "Weathering can dramatically impact those without stable housing, causing individuals to prematurely age by 10 to 20 years beyond their chronological age."
Although they may exist as outcasts in our midst, in a realm beyond the everyday thoughts and concerns of we who are securely housed, all of us have a practical stake in the heath and well-being of the homeless.
Public resources, principally in the form of Medicaid, cover the tab when homeless citizens end up in hospital emergency rooms, which too often function -- never efficiently -- as their primary care providers.
How we are dealing with the homeless, or not, has to be a policy priority.-- which is why we all should appreciate what the Blue Cross Blue Shield of Massachusetts Foundation has done in its latest research report on the topic of supportive housing programs for the chronically homeless, released Dec. 22.
The study examined the effect upon Medicaid expenditures of two statewide programs, Home and Healthy for Good, and Social Innovation Financing Pay for Success, which have served, respectively, more than 1,100 and more than 800 formerly chronically homeless individuals since 2005 and 2015.
The study found that:
-Individuals enrolled in permanent supportive housing programs had significantly lower per-person, per-year health care costs on average, compared to a cohort of homeless that did not receive such services.
-Individuals in these programs received significantly more mental health services; however, the cost of those services was more than offset by lower utilization of hospital inpatient and emergency department services.
-Supportive housing models may produce health care costs savings and also positive health effects through more consistent access to mental health services.
Said Audrey Shelto, president of the foundation, This "...adds to a growing body of research that demonstrates investments in social determinants of health -- in this case supportive housing for the chronically homeless -- not only lead to better health, but also provide a significant return in the form of lower Medicaid costs...the data are in: People (in supportive housing) are getting more of the services that they need and at net lower cost."
Getting people off the street is the right thing to do, morally and financially.
For more info, go to bluecrossmafoundation.org
SHOUT-OUT TO EASTERN BANK: As reported today by The Boston Globe's Jon Chesto, the Eastern Bank Charitable Foundation has just awarded $3 million to various non-profits, "primarily with the goal of addressing homelessness and other housing concerns." Among the largest recipients of that money, Chesto wrote, is the Pine Street Inn, "which is struggling to keep up with the demand for homeless beds in Boston."
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