As housing prices increase, so do unhoused patients

As housing prices rise, providers at the Community Health Association of Spokane have also seen an increasing number of unhoused patients.

In 2020, CHAS staff had roughly 71,000 encounters with unhoused patients — which increased to 75,000 in 2021.

The organization’s southern clinic service area — which encompasses Latah, Asotin and Nez Perce counties, as well as part of Whitman County — appears on paper to have fared better. Staff had 9,800 encounters with unhoused patients (more than 2,200 individuals) in 2020 and 8,900 encounters (more than 1,800 individuals) in 2021.

Despite that reduction, staff can’t say for sure whether the unhoused population shrank, or whether they were just harder to reach. Kelly Lanman is a member of CHAS’s homeless outreach team that makes trips to Pullman, Moscow, Lewiston and Clarkston.

“(CHAS), along with a lot of other health care facilities, really utilized telehealth services (during the pandemic), which is a bit challenging for the underserved,” she said. “Many of them don’t have phones, and if they have phones, finding a place to charge their phones is difficult. I think that that has a lot to do with the decrease that we saw.”

As the Tribune reported in January, trying to accurately count homeless populations can be challenging at the best of times, and was even harder the past two years because of the pandemic. Unhoused people lack a consistent shelter or places they can be reached, which makes both surveys and accessing medical care difficult.

How housing is defined also varies. The survey that was run in January, which is part of efforts by the U.S. Department of Housing and Urban Development, doesn’t count people “couch surfing” as homeless. But the instability of not having a permanent place to stay can still negatively affect health care access, said Deb Wiser, Chief Clinical Officer at CHAS.

“They’re temporarily staying somewhere, but are still really unhoused, because they don’t have that stable environment at home,” Wiser said. “That population has grown tremendously, and it really does cause a lot of barriers to getting the care that they need.”

As a Federally Qualified Health Center, CHAS collects patient information that includes food security, and demographic and housing information, said Tamitha Shockley French, director of communications for CHAS.

“It covers people who are living on the streets, it covers people who might be living in a shelter but don’t have permanent housing, people who might be living in cars or doubling up,” she said.

One of the biggest barriers to health care for the unhoused is instability, Wiser said. Not only are patients harder to contact, but once they do have appointments it’s harder for them to keep them without stable housing, transportation or income.

“I might have my staff make an appointment with a patient two weeks from now,” she said. “Two weeks from now, they don’t know where they’re gonna be staying, they don’t know where they’re going to get their next meal, whether they even have that written down somewhere or have a regular schedule enough to be able to figure that out. It becomes very low on the priority list in terms of trying to figure out your day -to-day basic needs.”

Wiser said she believes the overall rise their clinics saw in unhoused patients from 2020-21 would have been larger if the pandemic hadn’t limited their ability to access patients.

“Part of that had to do with us having some decreased access due to the COVID numbers and staffing,” she said. “So, I think the need was actually a little bit higher than what we were able to provide.”

Many of the unhoused people Lanman has worked with in recent years are between the ages of 18 and 22, who lack the money to afford housing and have recently lost access to support systems they had as minors, she said.

“Our school districts here are amazing. They really go the extra mile to help support the students,” she said. “Then they turn 18, then they’re not eligible for those same services, and they’re kind of lost. And as far as someone in that age range, to be able to afford housing — that’s really difficult right now.”

The outreach team doesn’t provide medical care, but helps connect patients to services they need including in-office and telehealth appointments.

The team will also help unhoused community members with tasks such as housing paperwork or job applications.

Though not everything the outreach team does falls strictly under the guise of traditional health care services, they’re integral to overall wellness, Lanman said. The organization is looking beyond acute medical concerns to social determinants of health. Basic needs like food, shelter, and utilities are part of that.

Last year, CHAS also implemented its street medicine team in Spokane, which is made up of doctors and advanced practitioners who visit people living on the streets, in shelters or at transitional homes.

The providers can do assessments, treat minor injuries and help provide necessities such as hand warmers for patients. The team also helps with transitions of care from hospitals.

“It’s sort of a trust building exercise,” she said. “They can help with wounds and some basic necessities. Sometimes they just give those little hand warmers out. And sometimes they do really full assessments and help connect them to the care they may need more in a clinic setting.”

In addition to the Spokane street medicine teams, Wiser said CHAS is working to expand its mobile medicine programs, including for rural locations that lack access to public transportation.

One obvious solution to the problem, Lanman said, is more affordable housing. The community is also in need of better access to mental health services, she said.

“We need more mental health services that take Idaho Medicaid and the uninsured,” she said. “I think those are the two big things.”

Sun may be contacted at rsun@lmtribune.com or on Twitter at @Rachel_M_Sun. This report is made possible by the Lewis-Clark Valley Healthcare Foundation in partnership with Northwest Public Broadcasting, the Lewiston Tribune and the Moscow-Pullman Daily News.