Sitting next to a campfire in a homeless encampment in a wooded area in Providence, emergency room physician Dr. Rebecca Karb found herself looking through a man’s hospital discharge papers.
The man was homeless and couldn’t understand his diagnosis or remember what happened to him when he had been admitted to the ER two weeks earlier. He only knew that he had brain cancer.
Karb found out he had been admitted for head trauma and did not have cancer but a brain bleed. The man was treated and discharged like every other ER patient and needed additional medical care. But with only the streets to turn to, he had no way of getting care on his own.
This was one of the first patients Karb met with last year as an outreach case worker for House of Hope Community Development Corp., a nonprofit that helps people who are homeless in Rhode Island. Karb along with Sara Melucci, House of Hope director of outreach, and other caseworkers were able to coordinate doctors’ appointments for the man and help him find permanent housing within months.
While the man was one of 1,000 people House of Hope works with annually to bridge gaps in their health care, there are many more the nonprofit would like to reach. But the recent rise in homelessness across the Ocean State has made it more difficult to find and care for patients in need, Melucci says.
“It’s harder for us to maintain our relationships with them because we’re not able to maintain consistent contact,” Melucci said. “Often it means we can’t work as intensively one on one with each of our clients as we would like.”
A Rhode Island Foundation study released in April found there are more than 1,500 people experiencing homelessness in the state, a 43% increase since 2020. The study also reported that Rhode Island had the second-highest increase in the U.S. in unsheltered homelessness, with over 300 people at any given point.
The statewide housing shortage, which has led to increases in rent prices, is a main reason for the rise in homelessness. James Rajotte, R.I. Executive Office of Health and Human Services director of strategy and innovation, says housing has remained one of the most important social determinants of health outcomes in the state.
People who are homeless tend to suffer the same medical issues as the general population, Karb says. But without access to consistent medications and treatments, they become sicker and may require more-complex treatments, making it harder for them to secure and afford housing.
Amid the spike in homelessness, shelters across the state are also stretched thin, with more than 1,200 people on the state’s emergency shelter waiting list. Karen Santilli, CEO of Crossroads Rhode Island, says there are almost no vacancies in any of Crossroads’ five shelters.
As shelters remain filled, Santilli has noticed more clients with catastrophic health issues such as strokes, as well as people with serious mental and behavioral health conditions. For those dealing with these challenges, shelters are difficult environments to manage because of their small size, lack of privacy and limited specialty medical resources, Santilli says.
As a result, people facing homelessness – such as the man Karb and Melucci cared for – often choose to remain unsheltered or rely on ERs for temporary safety and medical care.
“The emergency department is the health care safety net of the system,” said Karb, who is a contractor with House of Hope. “There’s overcapacity in general … so it becomes even harder to appropriately help people that come in with social needs on top of medical needs.”
But ER visits are costly. One study concluded the average price for a single ER visit in Rhode Island is $1,750, approximately the same as a month’s rent.
To address Rhode Island’s rise in homelessness and related health care costs, Sen. Joshua Miller, D-Cranston, introduced legislation in the General Assembly called the Restorative and Recuperative Care Pilot Program. The bill would direct EOHHS to use Medicaid funding to create a program that provides medical services for people experiencing homelessness and help them access permanent housing.
“When you stabilize somebody’s housing, you also help to stabilize their medical condition, and therefore the expenses go down – it’s really almost that simple,” Miller said.
The legislation has passed the Senate for the sixth year in a row but has previously failed to make it past the House. Rep. David A. Bennett, D-Warwick, introduced the House companion bill, which was held for further study by the House Finance Committee on May 17.
Though opponents of the bill were hesitant to use more Medicaid funds, both Miller and Bennett had been hopeful it would pass because this is the first time the Centers for Medicare and Medicaid Services has worked with the state to draft the legislation.
“Then we can start helping more [of] the disadvantaged people,” Bennett said. “The most vulnerable people in our state are the ones that [we’ve] got to focus on.”
Whether the legislation passes, homeless advocates say the best health care treatment for those experiencing homelessness is safe housing.
“We see that once folks have the stability of housing, they’re not having to live in survival mode,” Melucci said.
