On Health and Homelessness

Everyone calls her T. Tammy’s blonde hair is held up in a ponytail and her tongue piercing sparkles when she talks. The radiation treatment for her lung cancer has left small burns on her legs, her hands and on the tip of her nose. It feels like being in a microwave, she says, you’re slowly cooking from the inside out. For 20 minutes the machine goes click, click, click, and she doesn’t feel a thing, just the pressure of the metallic fishnet on her chest. But an hour later everything tastes like metal. She feels the heat waves inside of her, coming out, drenching her in sweat.

If she could, she would do this twice a day, like the doctors recommend. But each treatment costs $80, money she cannot afford. So she goes once a day, some days.

Tammy Weasenforth is 52 and unemployed. Since she doesn’t have health insurance, she applied for Medicaid a year ago but hasn’t been approved yet. For now, she has a place to stay, but that could change any moment. She has been homeless before.

Tammy’s situation is not rare. Most people who are unemployed and homeless are also uninsured. According to the National Coalition for the Homeless (NCH), 55 percent of the homeless population has no medical insurance. Homeless people have shorter lifespans than those with a stable residence, and they become three to four times more likely to die prematurely, most likely due to untreated medical problems.

Healthcare is not just a challenge for homeless people – it can also contribute to making them homeless in the first place.

According to the Department of Housing and Urban Development, HUD, about two million people in the United States were homeless in 2009. But on any given day, about 112,000 people fit the federal definition of “chronic homelessness” because they have been continuously homeless for a year or more or are experiencing at least their fourth episode of homelessness in three years.

“Say you are a construction guy and you have a stroke or you develop severe arthritis, then you’re not able to do day labor any more – but you are still not eligible for Medicaid,” says Randy Stacey, director of the Helping Hands Clinic in Gainesville, a clinic that provides free medical and psychiatric care to the poor and destitute.

Emergency rooms across the country are required by law to see patients in need of immediate medical care, but there is never a follow-up, making it very likely the condition will return, Stacey says.

“You can’t get care until you are urgently ill, so it really isn’t a good system,” he says. “If they took care of you in the beginning, they would save money in the long run.”

More than 5,000 people have visited the Helping Hands Clinic over the past 20 years. They have open clinic on Monday nights and a women’s clinic on Thursday nights. This year they estimate they will treat about 400 people.

Respiratory infections like bronchitis and emphysema are very common because of smoking, sleeping outside and cold nights. Frequent falls, cuts and scrapes also get easily out of hand. One man, for example, had an infection from a cut he sewed up himself with needle and thread.

With Medicaid, homeless people can get a prescription at a hospital, but they won’t have money to pay for medicines. Seroquel, for example, a drug that treats depression, PTSD and schizophrenia, costs $400 for 30 pills.

A major cause of depression among women is domestic violence, whether they are experiencing it now or when they were children. Though the majority of homeless people are adult males, the fastest growing segment is women and children. Homelessness can be harder for women, Stacey says, because they are more vulnerable to be sexually assaulted, taken advantage of or robbed.

Not that they should be underestimated. Many of these women are tough. Stacey knows a woman, for example, who is 56 and has terminal cancer. She had a 13-hour surgery to remove a tumor, part of her tongue, the roof of her mouth and part of her jaw – all while living in the woods.

While “some women will get together with a man just so that they don’t have to deal with five others,” Stacey says, others see getting pregnant surprisingly as a good thing, because as long as they are pregnant they get housing in emergency and transitional shelters set aside just for women in their situation. Some women end up in prostitution even while pregnant, which increases the chances of contracting sexually transmitted diseases and then transmitting them to the baby.

“[Homeless people] are trying to meet [their] basic needs like food and shelter,” says Sabrina Edgington, program and policy specialist at the National Health Care for the Homeless Council. “So [they’re] really putting behavioral and physical health second.”

Tammy knows how hard it is to manage a disease without money, and not just from her lung cancer. In the seven years she has been living in Gainesville, Fla., she has broken her back two times. The last time was three years ago on Nov. 1st. She was riding her brand new orange-and-blue bike a minister had given her from a donation, when at 12:30 p.m. a car hit her from behind. The driver quickly disappeared.

Tammy filed a report with the police. A hit-and-run accident is considered a third-degree felony under state law. If the police don’t find the person responsible, the victim is entitled to $14,000 in compensation, but only if he or she is employed. But since Tammy didn’t have a job, she didn’t qualify for it.

Her voice fills with frustration, but it doesn’t crack; it grows stronger. “The system is supposed to be about rehabilitation,” she says, “but it really is designed to keep you in.”

She broke two ribs and had to spend three days in the hospital. Afterwards, she got a prescription for a $1,500 brace. She couldn’t afford it though, so she had to lie still for six weeks. Luckily, she had roommates who helped her with food and basic necessities.

Sabrina Edgington says cases like this are very common. “I think our economic system always predisposes people to being homeless,” she says, “the same way our health care system does.”

Laws that criminalize homelessness abound in Gainesville. The National Law Center on Homelessness and Poverty and the NCH, named Gainesville the fifth meanest city towards homeless people in 2010. The list is compiled taking in consideration the city’s laws that criminalize homelessness; laws that, for example, make it illegal to sit, sleep or place personal belongings in a public space. Three of the top five meanest cities are in Florida.

But there are measures that can drastically reduce homelessness, she adds, like providing universal health care, increasing the minimum wage or supplying an adequate stock of subsidized affordable housing, which she believes is key to ending the cycle of illness and poverty.

Grants for these types of projects became available to institutions across the nation after landmark legislations were passed in the 1980s, when the Department of Housing and Urban Development, or HUD, worried about a homelessness epidemic.

More recently, in 2007, the Homeless Access to Recovery through Treatment Act, or HART, was introduced in Congress, but it stalled after it was referred to a House subcommittee. The bill would have strengthened and expanded substance abuse and mental health services to indigent people and also ensure people discharged from rehabilitation facilities went into stable housing, a key step in eradicating homelessness at the root.

Over the years, there has been conservative opposition to such legislation. Why should working taxpayers pay for services for people who are not working or paying taxes?

“It’s actually an investment,” Edgington says, “because these permanent housing support programs reduce costs in the long term.”

If homeless people don’t have to return to the street after a car accident or chemotherapy then they can recuperate, she argues. They won’t use costly emergency support systems like ERs and emergency shelters as much, reducing public costs and hospital use by 50 percent, she estimates.

Many days Tammy is in so much pain from the radiation that she cannot leave her Section 8 apartment. This makes it harder to find a job. But she tries because she knows that as long as she is unemployed she won’t have enough money for the required radiation treatments to recuperate – so that she can get a job.

This cycle is her life, but the pain doesn’t show. She still smiles. She jokes, she laughs. She remembers a time before her problems started 14 years ago.

She and her husband owned Apple Mountain Engineers in Linden, Va., where they worked installing and repairing sewage pipes. Back then she earned $850 a week.

But then at 33, her husband Jim died from an aneurysm. She was left alone with their 8-year-old daughter and 12-year-old twin boys. Everyone kept saying, “If Jim were here, things would be different.” She couldn’t live with that, so she sold her share of the company.

Problems began and so did her depression. She was prescribed Xanax, a drug that treats anxiety, depression and panic attacks. By breakfast she would take six Xanax pills, and by the end of the day she would finish a 12-pack of beer. Everything started to deteriorate: her savings, her relationship with her kids, her sanity. She was taking the prescribed antidepressant, but something wasn’t right. She was more and more depressed. She felt the pills had something to do with it, so she stopped taking them.

Tammy admits her lung cancer may be self-inflicted since she smoked crack and cigarettes for a long time. Now, she is over drugs and depression. But she is not over being unemployed. She’s not used to it; she doesn’t like it. Since she was 14 years old she had had a job, until now. In the past few weeks she has worked cleaning houses and taking care of people with disabilities. She also worked tending horses during the night, but the man who hired her never paid her and left her stranded in Ocala.

Recently, however, life has been getting a little better for her. Her cancer is now 27 percent in remission.

“That’s got to be good, right?” she says. “I don’t know what it means but I’ll take it over 0 percent.”

When her radiation begins at 3:30 p.m., at the University of Florida Shands Davis Cancer Center, she feels like she’s in a tanning bed – except she’s secured down and her skin is cooking. They offer pain medication, but she doesn’t want any of it, she has taken enough medications and drugs in her life.

By now, she has had IV with stabilizing fluids injected in her left forearm so many times, the tattoo she has there in memory of her husband is ruined. But she doesn’t mind today. She is feeling strong.

“I’m going to beat this,” she says. “I’m confident I’m going to make it.”