Vital Times 2020 - 73

Before the COVID pandemic, there was growing
recognition in the medical community that healthcare
for the homeless cannot be delivered reactively. A
broad group of leaders in the medical and advocacy
communities have launched a new initiative to
advance the provision of health services and stop
preventable deaths in the Orange County homeless
community. Broadly speaking, the collaboration will
focus on flexible urgent care services, delivery system
innovations, and better care coordination. While
many Orange County physicians do not practice in a
community clinic setting, we can all play an important
role in this effort.
For example, CalOptima's analysis found members
experiencing homelessness are six times more likely
to have an emergency department visit and seven
times more likely to be admitted to the hospital
than non-homeless members. That means that my
colleagues and I in the anesthesiology specialty
are most likely to encounter a vulnerable individual
when they are presenting with an urgent matter that
requires surgical intervention.
Rather than exempting us from responsibility, every
one of these encounters represents an opportunity.
For one thing, we know that the homeless are more
likely to have substance abuse diagnosis and more
likely to have a behavioral health diagnosis, and
less likely to receive preventive healthcare and
health screening services. We also know a common
condition in the homeless population is respiratory
infections.
That context suggests that anesthesiologists must be
highly attuned to patients' medical histories, including
living conditions. We should strive to optimize
the use of non-opioid alternatives in surgery, and
appropriate non-opioid medications for post-operative
pain, to ensure we do not unintentionally exacerbate
substance abuse disorder issues. Post-operative
pain management can be challenging in patients
without stable living conditions. Good multimodal

multi-disciplinary pain management is vital, and
clear communications regarding risk is of the utmost
importance. Discharge instructions should help postsurgical patients understand their increased risk of
respiratory infection -- and patients will need to know
where they can go for immediate care if concerning
symptoms begin to emerge. Symptom monitoring
and education about health safety measures have
become that much more urgent as the COVID-19 crisis
continues to layer itself on top of the homelessness
crisis.
So, let's use this moment to recommit to making
real progress in reducing health risks for those
experiencing homelessness. Imagine the progress
that will be made when all medical providers
collaborate closely to ensure that, after urgent
physical or mental health care is provided, patients
experiencing homelessness are linked to support
teams that keep them enrolled in managed care
programs. This way, they will be able to access
wellness programs that range from crisis stabilization
to outpatient support. Additionally, hospital navigators
can focus on homeless-specific discharge planning
and care coordination and increased mental health
and substance use disorder treatment.
The mortality data should shock us all; we do
not have the luxury of passivity. With a pandemic
continuing to attack our community, massive job
losses and dramatic economic decline, the number
of people experiencing homelessness will continue
to rise. However, as our community joins together
to surround homeless individuals with supportive,
compassionate healthcare and social services, we
prove that we live our values by caring for the most
vulnerable among us.

Annual Publication 2020

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Vital Times 2020

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