The holiday season can be an especially difficult time for those who don't have the comforts of a permanent address and are forced to live on the streets. Toss a health condition like diabetes into the mix, and life can get pretty unbearable.
We'd heard that some homeless shelters and clinics were making special efforts to help homeless folks get a handle on their health, and we wondered what exactly could be done. Our correspondent Mike Lawson volunteered to look into the issue by talking to some people on the front lines.
Turns out great minds think alike... While Mike was busy investigating, Diabetes Forecast published a longer article on this very topic just a few days ago. That one's definitely worth a read. And don't miss what Mike reports on our end:
Special to the 'Mine by Mr. Mike Lawson
It might be easy to complain about the difficulties that accompany a chronic illness like diabetes. We can't sit down to eat without doing complex arithmetic. We have to deal with loads of stigma and self-criticism. But have you ever wondered how you would do it if you didn't have a home?
The rate of diabetes among people who are homeless is nearly impossible to track, but researchers estimate that it is higher than among the general population. And life expectancy for a person without a home is just 45-49 years, according to a study done by the National Health Care for the Homeless Council. The NHCHC also reports that the number one cause of death among the homeless population is complications related to chronic conditions like diabetes!
Things like nutrition and testing blood glucose levels take a back seat when a person is worrying about where they are going to get their next meal or whether someone is going to steal their meager belongings. Treating diabetes is a challenging task for any healthcare professionals, but treating patients who are also without a home is double-challenging.
We reached out to some homeless shelters and clinics in the hopes of scheduling a walk-through to get a personal glimpse at the D-care happening in these spots, but HIPAA and privacy concerns prevented us from getting that inside view. So instead, we talked to some key people working "in the trenches."
One of those is Jason Odhner, a registered nurse and co-founder of the Phoenix Community Clinic in Phoenix, AZ (a brand new spin off of the Phoenix Urban Health Collective), who says that treating the homeless population is getting harder and harder.
"As we continue to cut funding for programs, it becomes more difficult for people to do important things like check their blood glucose or have labs done," he said.
Odhner also works as an ER nurse and says that he often sees people who end up in the emergency room with diabetic ketoacidosis because they don't have access to the proper medicine or supplies.
"For the price of the ER visit we could have provided 30 years of dignified care," he said. "This is an incredibly broken system."
Another worker in the trenches is Dr. Jim Withers, who has dedicated his professional energy to what some call "street medicine." He co-founded Operation Safety Net, which is part of the Pittsburgh Mercy Health System in Pittsburg, PA. Operation Safety Net provides healthcare to people living on the street, but Withers describes it differently: "The program is providing people with hope," he says.
"Our philosophy is to treat people where they are," said Withers, who has been treating homeless people since 1992. Operation Safety Net has helped transition more than 850 chronically ill homeless people into permanent housing since it started, and many of those people have been living with diabetes.
Like all other segments of the population, incidents of type 2 diabetes are on the rise among the homeless. And the challenges of treating this segment are compounded by circumstance.
"It's hard to explain how insidious uncontrolled glucose levels can be," said Jan Boyd, a registered nurse who works with Withers on Operation Safety Net. "People on the street don't usually seek medical care unless the symptoms are making them uncomfortable. With diabetes, discomfort comes too late."
Boyd explained that getting proper nutrition is difficult for people on the street. Many PWDs on the street are lucky to eat anything, and Boyd says that soup kitchens and food-assistance programs are not focused on diabetes-friendly options because they are more concerned with providing the highest quantity of meals at the lowest price.
Long periods of elevated glucose can also accelerate tooth decay. Withers said that a large percentage of their patients with diabetes have infections in their mouths that make it difficult to control glucose levels. "Whenever possible we try to find free clinics that will help do tooth extractions for people."
Boyd said that Operation Safety Net makes sure that all of their patients with diabetes have a working glucometer. "Finding blood glucose monitors for everyone is easy, but making sure everyone has strips to use with them is much more difficult."
Even when a person on the street is dedicated to making good health choices, he or she is often faced with additional challenges that many of us never have to consider. "There is no safe place to keep medicines and supplies," said Withers, referring to theft and temperature issues. Operation Safety Net staff teaches patients with diabetes how to adjust insulin dosage and count carbohydrates, but they also have to teach skills like coming up with clever places to store insulin.
Another challenge of treating homeless PWDs is that many of them do not have a support system around them to watch out for symptoms of hypoglycemia. When possible, Operation Safety Net tries to teach shelter staff about the signs of low blood sugar, and the program also helps homeless PWDs get medical alert bracelets.
According to Withers, even good-intentioned people can impede a person with diabetes from treating themselves properly. "On the street, supplies like syringes and insulin aren't just stolen; sometimes they are also confiscated by law enforcement or hospitals," he said.
If he could only write one prescription for a homeless person with diabetes, Withers said he knows what he would prescribe: "The best diabetes treatment is housing."
How You Can Help
If you're interested in helping people who do not have homes in your area, and are also passionate about diabetes advocacy, the first step is knowing where to look. Finding homeless shelters and food banks can help you pinpoint how to help.
Beyond giving money, Boyd suggests you think about some practical types of donations you might make. A case of bottled water is obviously more beneficial to local food banks and shelters than a case of sugary soda. Boyd also says many food banks stock mostly shelf-stable foods that are higher in sodium, fat and sugar, so "if you're able, donate fresh foods like apples."
All fruits and lean meats can add a nutritious boost to the inventory of your local food banks and soup kitchens.
It's a smart idea to check with the location before purchasing items to donate to ensure that they accept perishable items. You can also ask if there are any particular nutritional gaps that they're experiencing that you can help with.
Donating toothbrushes and toothpaste to local shelters can also benefit all of the clients that use the services, and can be particularly beneficial to homeless people with diabetes, who need to pay special attention to oral health. (The Forecast article has some additional good tips about what to consider donating.)
After researching this issue, I know I'll be less inclined to be bothered by my diabetes his holiday season — I have a roof over my head, and that's nothing to be taken for granted.