Privacy For Homeless People

HIPAA Regulations and Homeless Memorial

Background
The Health Insurance Portability and Accountability Act (HIPAA) was signed by President Clinton in 1996, but the privacy provisions did not go into effect until 2003 in the United States and the enforcement rules were not in place until 2006.  They govern most health care organizations including mental health providers from releasing information about patients or disclosing health information collected from health insurers, hospitals, clinics while working to upgrade all records to an electronic platform.  The Coalition has been overseeing a homeless memorial day since 1987 in Cleveland with the reading of the names of those who died over the past year.  We call every social service agency to gather names, and then read an alphabetical list of homeless or formerly homeless people who died over the past year.  In the 1990s, we were reading 10-25 names.  These last two years, we were reading 40 to 50 names.  Our national sponsors for this event are the National Coalition for the Homeless and National Health Care for the Homeless Council who both help coordinate memorials all over the country. 

We have had no problems collecting names because privacy does not survive death.  All births and deaths in the community are public events that are announced in the paper.  The coroner does not identify people as homeless, but they will release the names of unclaimed bodies every year or those who were previously buried in the "Potter's Field" at the cemetery off Warrensville Center Road.  This year, only six days before the memorial, I was notified by Mental Health Services staff that they could not provide names with a link to a 2002 Q& A about whether HIPAA patient information survives death.  No meeting, no discussion, and no assurances that the agency talked to other health care organizations in the United States who participate in the memorial.  Just a two sentence e-mail was all we were given from MHS.  We had received names from the agency in previous years, and we sent the first letter asking for help collecting names in mid-September.  We heard nothing from the agency, which happens to be the largest homeless social service provider in Cleveland until December 15. 

Another bit of background information, NEOCH is one of the most sensitive organizations in the community when it comes to privacy.  We have filed numerous complaints regarding violations of privacy with social service providers.  When we had to submit data to the County regarding our clients, we assumed that the client would want to remain anonymous in the system and so they had to affirmatively declare that they wanted to have their social security number used in the County management system.  Most providers force the client to affirm that they want their social security numbers removed from the management information system, which is often uncomfortable when they are hoping for a bed that night.   We oppose the use of the County Homeless Management Information System (HMIS) in the shelters because it is too easy for private client data to be viewed by other social service providers to construct a registry of "bad homeless people."  Mental Health Services submits personal information to the County including social security numbers through the HMIS network, and we have even caught agency staff declaring that submission of social security number was a requirement for entry into a MHS facility (which is wrong).  So, while we do a great deal to protect the privacy of homeless people, we understand that once a person dies they really cannot object to their name being remembered and honored at that point. 

Why HIPAA Does Not Apply to Homeless Memorial
The Coalition is not releasing patient information as part of the memorial.  We are not saying, "Joe Smith who was mentally ill and sleeping at Lakeside and was a patient of MHS died this year."  We are not even saying that the person was homeless in 2011 and then passed away.  The list is a strictly the names of people who passed away in 2011 and had previous experience with homelessness. It comes from many different sources and is not divided by agency.  While homelessness certainly contributes to bad health outcomes, it is not a medical condition.  We also have used street names on the list and sometimes we only have their first name.  If the agency was in fact worried about the privacy of their clients there are ways around this concern.  With a little more time and some discussion, we could have satisfied the issues brought up by the MHS attorney.  Involving an attorney in this type of community service is why lawyers are held in such low regard and the reason we have warning labels on everything we consume, wear, or even use to clean with.  "Warning: May Contain Traces of Nuts" on a Hershey's Almond Bar or "Do Not Take if Allergic to Aspirin" on the side of a Bayer Aspirin container are typical of the nonsense we have to put up with today because of well meaning but overly nervous attorneys. 

We suggested calling the National Health Care for the Homeless Council who should understand HIPAA as a leading health care organizations and co-coordinator of National Homeless Memorial Day.  I have no idea if they ever did this, since no one at MHS would talk about this decision.  They just kept saying, "we want to help and we understand your position, but we cannot."   We suggested calling the many health care for the homeless organizations in the United States who participate in and in many cases even organize a Homeless Memorial Day in their cities, but heard nothing except a couple of short e-mails.  This is the kind of frustration that homeless people have to put up with everyday.  The lights are out a 11 p.m. for no good reason even if the NBA playoffs go long or some agencies throw away all a client's valuables when they are transported to the hospital by ambulance, and then when they come back they are even barred from digging through the trash to retrieve their own original birth certificate or family pictures.  If the shelters were more transparent and acted like members of the community who were always trying to provide a hand up, we would all be better off.

HIPAA Privacy Claims
The Center for Democracy and Technology is lobbying to get an improvement in HIPAA regulations, and they have criticized the enforcement of HIPAA regulations.  Here are their comments to Congress from 2009.

"Unfortunately, the HIPAA rules have never been adequately enforced. As noted above, HHS
has not levied a single penalty against a HIPAA-covered entity since the rules were implemented (footnote 18). The Justice Department has levied some penalties under the criminal provisions of the statute – but a 2005 opinion from DOJ’s Office of Legal Counsel (OLC) expressly limits the application of the criminal provisions to covered entities, and prosecutors seeking to enforce criminal penalties against individuals have had to rely on other federal laws."

There have been thousands of complaints, but very few have resulted in any prosecution or even any follow-up from the Department of Health and Human Services.  The handful that were prosecuted were obvious huge violations in which the release of information was to cover some criminal enterprise or obvious stupidity such as throwing away un-shredded patient information in an unlocked dumpster.  The likelihood that the local agency could have any problem with HIPAA and homeless memorial day is nearly non-existent.  We were willing to sign any agreement between the two agencies that we would not disclose any patient information from the agency, but never heard anything back.  It is hard to guess why MHS took this position.  Was it that as the largest provider, they have a stake in keeping the numbers down?  Was it that they did not want to be bothered asking their staff?  Did they not want to participate in anything associated with the Coalition?  I have no idea what the real reason was because we never got the chance to sit down face to face and discuss the issue.  We were never given the courtesy of discussing this important event in Cleveland.  These names were lost to the community in 2011.

The training manual from the National office does not mention HIPAA problems.  But in searching the public record, I could not find one place where this came up as an issue.  As a board member of the National Coalition for the Homeless, one of the national coordinators, I have never heard any other city raise HIPAA as an issue.  I could not find any controversy regarding any memorial in any part of the United States with a Google search.  So, again the chance of any backlash against Mental Health Services is minimal.  If anything, the Coalition is taking the risk not the social service providers in our community.  If Nightline can feature an entire show reading the names of US soldiers killed in Iraq, then we should be able to honor those who passed away in our cities.  The US Military has huge health care costs and does respect HIPAA privacy concerns, but they release the names of those who are killed in action every week.  Our fear is that by standing behind unreasonably cautious legal advice, we will forget these individuals.  We will not recognize that homelessness can kill by keeping down the number of people on the memorial list.  As we say every year, these individuals are largely forgotten in life, it would be a crime to forget these individuals in death as well.

Brian Davis
Director of Community Organizing
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NEOCH Board Urges a No Vote on Issue 3

NEOCH Supports Universal Health Care By Any Means

The NEOCH Board voted to urge our Ohio members to oppose Issue 3 this November.  The board cited the confusing language on the ballot and the unknown repercussions it could have for other mandated government services.  The Board worried that the constitutional amendment declaring Ohioans could not be forced to obtain insurance could result in unnecessary lawsuits.  There is real concern that the amendment would make it impossible for a judge to order that a non-custodial parent to buy health insurance for their child.  Finally, there was concern over the State's ability to regulate insurance companies if this amendment is approved.

We believe that the Affordable Care Act will benefit our constituency, and should be expanded in Ohio.   At this time, very few of our constituents are eligible for Medicaid, because they are not determined to be disabled.  If we can enroll an additional 20 or 40 or even 60 percent of the homeless population in Medicaid, those resources would be freed to provide additional health care services to the population.  We may be able to provide additional mental health services or additional alcohol and drug services to the population when the law is fully implemented in 2014. 

The NEOCH Board understands that the only way to get close to universal health care in this current environment is to require individuals to maintain health insurance.  We do not believe that Issue 3 is unconstitutional and so this measure is largely symbolic.  The message with a "yes" vote is a statement that Ohio citizens do not believe that every citizen has a right to health care.  A yes vote means that crippling, life long debt should be a part of our health care system for one third of our population.  A yes vote is purely a cynical attempt to attack the President and supporters in Congress who passed the Affordable Health Care Act.

While we recognize that the American Health Care system is not perfect.  We believe that this is a small step toward universal health care in order to join the rest of the developed economies in the United States.  The symbolism of voting "NO" is that the United States needs to take a leap forward toward more health care coverage for those in the service sector, those living below poverty and without a disability, and we need expanded coverage for the Moms working two part time jobs. 

NEOCH urges a No vote on Issue 3.
Posted on Behalf of the NEOCH Board of Trustees
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Affordable Health Care Coming Soon

Photo by Pleasure Simmons

Health Care Forums: An Overview

I have provided an overview of each of the three UHCAN Affordable Care Act health care forums. Here is the summary of the first one, the second one, and last week we posted the summary of the last. I wanted to give a brief overview of all three together.

At the end of three highly detailed healthcare reform forums, I can say I am both more informed and confused about the coming changes. All forums seem to stress that there is potential for positive change, but that there are many obstacles to success, the largest one being that this is all a new system to the majority of patients and providers. Other concerns are: how consumers will fair purchasing their own insurance on the “exchange”; how providers will coordinating care in an equitable manner; and will there be an increase in primary care providers? We shall see how these all play out. More importantly will the increase in insured persons demand for services by 2014 when the Affordable Care Act is to be fully implemented be met with higher quality care or will overwhelmed care providers have to increase an already heavy work load? The coordination of care will likely be ineffective if there is not an increase in the work force to back it up. Dr. Richard Christi who spoke at the last forum voiced concerns about needing at least ten years to increase primary care providers due to the length of educational requirement.

Will the exchange be user friendly and if health insurance consumers are largely uniformed about the cost of medical services will individuals and businesses be able to appropriately purchase health care on the exchange? There are of courses great positives and no one at any of the three forums ever suggested that the changes in the United States healthcare system were not needed. Certainly more people being covered should in theory increase the health of Americans and reduce the crushing debt many incur due to medical bills. Increasing coordination and ease of services is beneficial to the consumer. However, change is coming and it is clear that participation in the delivery of care is going to require great effort from providers and patients to utilize the advantages and minimize the areas of concerns.

by Holly Lyon
Posts reflect the opinion of those who sign the entry.

Third Health Care Forum Overview

Health Care Reform and the Consumer

This is the third and last forum in a series of health care reform hosted by UHCANN. You can find our overview here and here and here on this blog. The last healthcare forum, National Health Care Reform Begins: The Delivery of Care Story took place June, 20 at Cleveland State University. This forum addressed how reform will effect the general public as consumers.

Speakers included:
Cathy Levine- Executive Director of the Universal HealthCare Action network of Ohio (UHCAN Ohio).
Gary Hartman- Director of Care management program for Uninsured for the MetroHelath System.
Peter DeGolia- Director of the Center for Geriatric medicine of University Hospital Case Medical Center and the Executive Director of McGregor PACE (program of all inclusive care for the elderly).
Aaron Smith- Emergency Medicine Doctor and assistant Medical Director for External Affair organizational effectiveness for Kaiser Permanente.
John Begala- Executive Director of the Center for Community Solutions.
Scheduled but could not attend Greg Moody Director of the Governor’s Office of Health Transformation. Monica Juenger- Director of Stakeholder Relations replaced Greg Moody from the Governor’s Office of Health Transformation.

This forum began with a presentation from a consumer talking about her terrible experience with lack of coordination in the current medical system. Pat Morgan, as a result has been left blind in one eye due to misdiagnosis and lack of follow up. She suffered needlessly after receiving surgery for a cyst in her ear, she was released with no prescription for antibiotics; had to fight to get the prescription and received no follow up information from the doctor after she had the surgery. This resulted in a severe infection. Personally she feels having an accountable care facility as a standard for medical needs would have alleviated many of the miscommunications and misdiagnosis that she experienced. She believes that an accountable care facility would have resulted in fewer tests, fewer doctor visits, shorter illnesses and would have lowered her cost of health care.

Ms. Juenger replaced Director Moody, and featured a powerpoint presentation called Medicaid Hot Spots. This slide show is available online at the Ohio Governor’s Office of Health Transformation (search under reports on their website. Ms. Juenger’s presentation was the same information that has been provided in the news in regards to the Governor’s plans for healthcare. The high cost of Medicaid being absorbed by the few and changing long term care. 96% of Medicaid recipients are low cost, while 4% utilize over 50% of expenditures. Sighting that Ohio per capita has a rate 52% higher in nursing home care and 12% higher in hospital care, but 8% lower in home healthcare than the rest of the country.

Also covered by Ms. Juenger’s presentation was Ohio’s poor performance in national ranking in regards to overall health and delivery of health care. The following are few of the highlights. Ohio is ranked 42nd healthiest state in the nation, 44th in avoiding Medicare hospital admission for preventable conditions, 44th most affordable Medicaid for seniors (6th from last), 40th in avoiding Medicare hospital re-admissions. Another key highlight was that while Governor Kasich plan is designed to save money and improve a fragmented system in order to provide a coordinated, efficient and ultimately better care system. But with regard to seniors and persons with chronic disease the goal is to reduce hospitalization and nursing care facilities stays in order to save money while improving care. Ms. Juenger pointed out that savings will not take place immediately, but will take a few years to actually see cost going down.

Cathy Levine Executive Director of UCHAN of Ohio said it will be important for consumers and consumer advocates to insure that patient center care is effective during this transition. This means transparency in delivery of service, changes in how providers interact with patients and most importantly leadership provided by consumer and consumer advocates. Patients will need to have a better understanding of their insurance, specifically pertaining to cost and coverage. Providers should not receive funds for “volume but quality.” Many Medicaid providers are paid for specific services they provide, this often results in unnecessary test as well as duplication of tests.

Gwyn Hartman discussed the MetroHealth medical home model that the organization implemented in 2009, which is a comprehensive onsite coordination of care program and is available at six of their locations. This program mimics the key components of an accountable care facility as described in the law. She stated that the number of uninsured patients continues to grow. At this comprehensive care program, all health care members who relate to a patient come together on a daily basis to share information. Care coordinator nurses work with high risk patients beyond their stay in the physical facility. This includes communicating with patients on daily or weekly basis. Hartman gave examples such as the diabetic that a care coordinator also schedules the patient with an eye exam in order to reduce emergency room visits and encourage preventative care.

Peter DeGolia discussed the PACE program and their comprehensive care provided to dual eligible seniors. Dual eligible refers to people who qualify for both Medicaid and Medicare. Peter provided the average medical needs of a baby boomer in a year time span:

• 1 in 10 have a chronic illness
• 77% has more than one chronic illness
• On average they attend 37 different doctors appointments annually
• They see 14 different doctors
• They fill 50 different prescriptions annually

DeGolia explained that hospitals are not the safest places for senior, as they can find the transitions disorienting and are exposed to various illnesses. Home care saves an incredible amount of money for the State. He did point out the problem with those physicians and nurses who currently provide care coordination are often not properly reimbursed under the current system. Sharing a personal example of a house call, (yes, Dr. DeGalio still performs house calls!) he went to a gentleman’s house and he treated him for pneumonia. DeGalio arranged health care aids to properly treat him and followed up with the patient in his home. He stated it was the right thing to do because he knew the patient would become disorientated in the hospital and risk the quality of his overall health. For this house call related to pneumonia he was only reimbursed $250. Had he had the patient admitted he would of had a plethora of tests to confirm he had pneumonia, and it would have cost the state thousands. DeGalio saved Medicaid and or Medicare substantial amount of money, but in many cases the best interest of the patient is not taken into account when these health care decisions are made.

Aaron Smith from Kaiser Permanente said that patients at Kaiser also receive service that replicate an accountable care facility. The most distinct difference is that Kaiser is a for-profit corporation. Smith was asked by an audience member if Kaiser being a profit based agency had anything to do with their model of care he replied, “Yes,” and went on to point out that from a fiscal stand point healthier patients save money. Kaiser Permanente currently covers 600 Medicaid patients.

John Begala focused his presentation on how health insurance differs from other products we purchase. The buyer and the provider often do not know how much the service that they are receiving actually costs. The bulk of medical costs are paid by somebody else; consumers rely on someone else to make choices for them with regard to the amount of care as well as the costs of that care. Begalia stated that the affordable care act is “Marvelous” in regards to expanding Medicaid (32 million will receive coverage with ACT; specifically 16 million will receive coverage under Medicaid.) However he is concerned that policy makers in DC do not fully understand what an accountable care facility is and is doubtful about the federal government’s ability to guide the implementation of something they seem to know little about.

I will evaluate the forum in a follow up posting.
Holly Lyon
Posts reflect the opinion of those who sign the entry.

UHCAN Health Care Forum

Delivery of Care Health Care Forum

This third and final forum will focus on the delivery system transformation encouraged by the Affordable Care Act and how that might impact the ways in which individuals will receive health care. It will feature Greg Moody, Director of Governor Kasich’s Office of Health Transformation, who will share how Ohio will implement the national health reform law so as to improve the quality and coordination of health care while reducing costs.

Panelists include:

• Cathy Levine, J.D., Executive Director of Universal Health Care Action Network Ohio and Co-Chair of Ohio Consumers for Health Coverage;
• Peter DeGolia, M.D., C.M.D., Director of the Center for Geriatric Medicine of University Hospitals Case Medical Center and Executive Director of McGregor PACE;
• Gwyn Hartman, M.B.A., Director of Care Management Programs for the MetroHealth System; John Begala, Executive Director of the Center for Community Solutions; and,
• Aaron Smith, MD, Kaiser Permanente.

Monday, June 20, 2011
4:00 to 6:00 p.m.

Cleveland State University
Levin College of Urban Affairs
Glickman-Miller Hall
Roberta Steinbacher Atrium
1717 Euclid Avenue, Cleveland
Parking in East 17th structure.

REGISTER NOW
www.urban.csuohio.edu/forum
or by calling 216.523.7330.

The forums are free and open tothe public.
Posts reflect the opinion of those who sign the entry.

Healthcare for the Low Income

Second Healthcare Forum Held at CSU

The topic of discussion at the second forum focused on how the Affordable Care Act will affect our economy. The essential goals behind health care reform are to create better access and quality at a more affordable price. With healthcare reform 32 million uninsured individuals will be insured. For clarity, Medicaid is state funded insurance for those with financial hardships while Medicare is federally funded for the elderly and disabled, something I habitually mix up. Both of these programs face big challenges with the implementation of healthcare reform. The forum had several knowledgeable speakers from a wide range backgrounds including:

• Thomas S. Campanella, a professor at Baldwin-Wallace College as well as the Director of the Health Care MBA Program.
  
• Bill Ryan is the President and Chief Executive Officer of the Center for Health Affairs and serves as the leading advocate for northeast Ohio hospitals.
  
• Dick Christie, MD. the Director of the medical Residency Program at St. Vincent Charity Medical center.
  
• Patricia Gray, PN, PhD, Vice President of Healthcare Education Initiatives at Cuyahoga Community College and
  
• Bette Bonder, PhD, Dean of the College of Sciences and Health Professions at Cleveland State University also spoke.

Campeanella stressed that the idea creating many Accountable Care facilities have great potential. Accountable Care Facilities are a key component in the new healthcare reform in regards to access and increasing efficiency and then ultimately cost. Accountable Care Facilities are essentially facilities that provide primary care practitioners that oversee and coordinate patients care. It is intended to improve the general health of citizens and prevent people from using emergency rooms as their only source of healthcare. This would necessitate an increase in the number of primary care doctors, nurse practitioners and physician assistants. Campeanella also predicted that private insurance companies would provide programs to those covered by private insurance company to create incentives to increase and encourage clients to lead healthier lifestyles. However, he cautioned that “just because you build it does not mean that they will come.” Undoubtedly having access to preventive and maintenance care will improve people’s health, but personal responsibility to seek out available services and address one's health needs on a day to day basis will play a big part in the success of health care reform.

Ryan focused on the role of hospitals in Cuyahoga County. He pointed out that locally medicine is big business especially with the number of hospitals and colleges that provide healthcare programs. He stated that 140,000 jobs in Northeast Ohio are healthcare related. However, Ryan pointed out that just because healthcare is big business does not mean that the community healthcare needs are met. He went on to say that most hospitals are approaching 50% of their patient’s being on either Medicare or Medicaid. Hospitals are having to re-evaluate how to best serve the needs of their communities. In his opinion, hospitals are starting to do just that and Ryan predicts this will increase in the future. He did comment that Accountable Care facilities are few and far between and therefore citizens are hesitant in accepting them at this time. Many communities have strong attachments to the hospital in their communities. Ryan used the Huron Hospital closing as an example and the developing of an Accountable Care Facility opening up in its place. (Although many of the residents concern over the closing of Huron Hospital had to do with not having an emergency facility in close proximity that could care for individuals in extreme medical distress.)

Christie, addressed the issue of the shortage of Primary Care Physician as well as Nurse Practitioners and Physicians assistants. He holds the opinion that many of the loan reimbursement and forgiveness programs for those going into primary care medicine will create little change as the 2.4% increase in funding for loan forgiveness is too little to create large scale change. Christie pointed out that at a minimum it will take 8 years to produce more primary care practitioners, just because of the time it takes to educate and train such fields of study. His prediction for healthcare did not echo the theme of potential. He also explained that it is costly to go into primary care medicine and that many go into specialty fields. Specialist make twice as much as a primary care doctor in order to cover the mountain of debt they incur from med school. Also specialist and research doctors are often med school professors, therefore students have more direct communication with specialist and are more likely to go into specialized care. Christie fells the Affordable Care Act is not going to be a “game changer.” Ryan chimed in that there is no new money coming in, and that healthcare access, quality and cost would all be positively affected with the creation of decent paying jobs and or public work programs.

Gray and Bonder outlined the extensive work Tri-C and CSU have done and will continue doing to prepare healthcare workforce for the coming needs. This includes using extensive partnerships to save money and attempting to meet the needs of the growing healthcare industry. However, there was a comment by both speakers that it will cost a great deal to train students in medical occupations due to the students needing exposure and practice in the field. It is hard to expand programs and that many of the programs have a two year waiting list and many of the recent grads are having a hard time finding employment. The example used was radiological technician programs which have saturated the market. Dr. Bonder made a great point at the end of the rather bleak forum when an audience member asked what can we do now to improve the problem in the future? Bonder suggested that people volunteer their time reading to children in underperforming school districts or other work with the next generation.

It was a somber end to an overwhelming forum. While there was some optimism expressed, intense hesitation at how successful healthcare reform will be was the bottom line message expressed at the forum . All forum are archived on CSU’s website with a link provided.

by Holly Lyon
Posts reflect the opinion of those who sign the entry.

Health Care for Homeless People

Photo by Cheryl Jones of the NEOCH Photo Project

Healthcare Initiative at NEOCH

The staff at the coalition advocate for quality and comprehensive healthcare for all people as a key component to ending homelessness and keeping people housed. This includes behaviorial health issues such as addiction and mental health problems. The cost of out of pocket healthcare can quickly bankrupt a financially comfortable family as well as a family living in poverty. It is a given that routine and preventative medical appointment is necessary throughout life in order to fulfill the most basic needs, and typically more complicated and expensive medical needs are sought as a person ages. The effects of the economic recession have caused greater numbers of people to seek out programs that provide free and reduced medical care.

NEOCH has been researching healthcare among people experiencing homelessness the last few years. In 2008 staff surveyed 300 homeless people and published a report called Heading For The Emergency Room: Ohio s Inability To Care For Its Poor, which outlined the finding of the surveys. The survey highlighted the fact that emergency rooms serve as the only place that poor people living in Cuyahoga County can find comprehensive health care. The 2008 study showed that preventative and maintenance care are often left unattended. For example, the majority of those surveyed had not been to a dentist in three years. It is the hope of NEOCH staff that we can raise funds to hire a Homeless Healthcare Advocate to serve the people of Greater Cleveland, below is a list of the project(s) the advocate would work on.

• Review Entry/ Discharge policy for nursing homes
• Review and solidify an alliance with direct health care organizations to develop common intake procedures.
• Review the coordination of services to discharge protocol between and within the different health care organizations especially those responsible for providing health care to homeless individuals
• Survey and meet with shelter director to learn about their interaction with the local hospital. This will include following up to see if both the local hospitals and shelters are adhering to the agreement that the County organized a couple of years ago to manage discharges into the shelters.
• With the development of the new health care law, develop recommendations in collaboration with Care Alliance to improve access and discharge and intake methods.
• Create steering committee to carry out recommendations on how to best serve homeless people locally.
• Review other similar program and highlight two of those that could be used as a model for Cleveland to improve access and long term health care outcomes.
• Provide a point person (health care individual advocate) for those experiencing homelessness who can advise a person experiencing homelessness about the services in the community.
  

Currently in the community there are only 8 to 10 respite beds available (that can only accommodate men) at a transitional facility. They can reside at this facility for up to four months. Shelter, especially the local emergency shelter, are not designed to help a person recovering from illness. Emergency shelters do not allow persons to stay in the shelter during the day, and those living in non emergency shelter are often not able to be in their sleeping quarters during the day. There is also the fact that shelter residents have no one to assist them with personal care issues or to monitor medication or to provide appropriate dietary needs. Care Alliance does a good job with medical clinics at some of the larger shelters and a doctor and nurse do regularly visit nearly every shelter in the community. But there is only the one facility that is specifically designed for respite care to those recovering from a health care crisis and do not have a home of their own.

There are many wonderful organizations that provide free or by donation healthcare to those experiencing homelessness in the greater Cleveland area, undoubtedly these programs save lives and lesson the health burdens of poor and homeless people. Unfortunately, there is a large demand for all health care services including treatment, counseling, dental, and rehabilitation. In order to be a healthy productive person, regular healthcare screenings are required. This is especially true for homeless people who face inclement weather, excessive time on the feet, poor nurturing, sleep deprivation, poor hygiene, self medication issues, or a lack of mental health services. It is exciting that in the near future poor and homeless people will have the majority of their preventative care fully covered by Medicaid and additional assistance with prescription coverage. While poor and homeless people will still face large barriers to healthcare, healthcare reform will offer many needed services and hopefully be a stepping stone for more comprehensive coverage that includes addiction services, mental health and reproductive health services to all fragile population.

by Holly Lyon
Posts reflect the opinion of those who sign the entry.

What is Happening With Health Care Reform?

Health Care Reform Forum at Cleveland State University

Clarity is one of the last word most people would use to describe our healthcare system. I had the opportunity to attend the National Health Care Forum: The Ohio Story, held at Cleveland State University on May 17th, the purpose of the forum, was to provide the public with information about healthcare reform. The forum gave a view of healthcare reform and how it specifically pertains to the state of Ohio.

Four speakers, all healthcare reform specialists in different capacities gave brief presentation on how the Affordable Care Act (healthcare reform) will impact the purchasing of healthcare, access and coverage issues of Ohioans in the coming years. Steve Millard, president and Executive Director of the Council of Smaller Enterprises, Lee Kamps, an independent health insurance broker, Kathleen Gmeiner, Project Director at Universal Health Care Action Network (UHCAN) Ohio and Carrie Haughawout, Assistant Director for Health Policy at the Ohio Department of Insurance all gave presentations. There were also two personal narratives by healthcare consumers who have both been affected by the aspects of healthcare reform that have already occurred.

Each speaker highlighted various aspects of the reform: Carrie Haughawout, discussed the various aspects of the act that have been implemented, what remains to be implemented, as well as describing the possible plans that consumers will purchase (a website that serves as a marketplace, often referred to as the Exchange) and the state of health insurance in 2014, when most of the reform will have been fully implemented. Lee Kamps, explained that healthcare reform is not a panacea for all the problems within the industry. He explained that the market will stay competitive because individuals will be able to purchase new policies if they are dissatisfied with one they have purchased or their employer has provided to them. In addition, he anticipates many large insurance companies will merge. He also felt supplemental (small plans that are meant to fill a gap in coverage) plans would become more prevalent and profitable.

Kathleen Gmeiner, described potential problems, the need of the federal government to create independent entities to oversee the Exchange (such as the state government) and the need of the federal government to set minimum qualifications for participation. She indicated that there was a need to provide mandated minimum qualifications to prevent inexpensive plans that provide minimal coverage. Steve Millard described the changes and what small business owners can expect with healthcare reform.

It was clear that healthcare reform if it is successfully implemented will provide better care for more people. A few examples key examples of how healthcare reform will benefit the uninsured, those who are under insured, and those with barriers to obtaining coverage are as follows:

• Insurance companies must spend 80 to 85% (depending on size of company) of income on care.
• No lifetime caps on healthcare reimbursements
  
• Not sudden or unexplained cancellation in coverage
• Must provide coverage even those children with pre-existing conditions
  
• Improvements in coverage of those considered “High Risk”
• Coverage of a myriad of preventive health services for those on Medicaid.
• Improved prescription coverage for those receiving Medicaid.

One of the most unique features of the forum was that it was non-partisan and appropriate for uniformed and well informed audience members. I was pretty much a novice to the subject myself, only hearing snippiest on the news about the act itself. I had heard far more personal opinion about the act than about the content of the new legislation. The forum allowed me to gain a rudimentary understanding of the current and coming changes, as well as supplied me with oodles of helpful information; I spent much of the following day at work reading up on the Affordable Care Act. I listed the resources given and highly suggest reviewing some of them as well as attending the remaining two forums that focus on economic impact as well how employment will be affected.

Below are the date, time and location of the remaining two forums.
National Healthcare Reform Begins, The Economic Impact on Northeast Ohio
Thursday, June 2, 2011 and Monday, June 20, 2011
4:00-6:00 p.m.
1717 Euclid Avenue
Maxine Goodman Levin College of Urban Affairs
Glickman-Miller Hall, Roberta Steinbacher Atrium
Cleveland State University

Other places to get additional resources:

• Ohio Consumer for Health Coverage (OCHC)--Report to the Community on the Implementation of the Patient Protection and Affordable Care Act in Ohio.
• Consumers Union, publisher of consumer reports, The Affordable Care Act: The First Year Discover What The new Law means For You And Your Family.
• Council of Smaller Enterprises (COSE), Health Care Reform Game-Plan (pertinent for small business owners).
• Universal Healthcare Action Network, UHCAN Ohio’s Helpline (614) 456-0060x 233 or e-mailmgreenham (at) uchanohio (dot) org.
  

Types of calls UHCAN accepts include:

• Uninsured caller who do not qualify for Medicaid and cannot explore the option of private insurance
• Low to moderate income level callers who want more information on affordable healthcare options and need help with navigation.
• Caller who do not qualify for Medicaid that need prescription assistance.
• Caller who do not qualify for Medicaid that have current outstanding medical bills.
• General Healthcare questions or concerns.

As mentioned before the forum also included two personal narratives from consumers affected by the new legislation. I thought it worthwhile to give a brief synopsis of the two stories shared, as one highlights positive change and the other describes a tragic situation reminiscent of pre-healthcare reform. After the introductions were made two narratives were shared. One was a middle aged mother talking about her sense of relief knowing her adult daughter could stay on her insurance plan until she was 26. The daughter recently graduated college, but could only find part-time jobs and did not have access to her own coverage. This was compared to the mother's own experience of not having health insurance until she was in her early 40s.

The second story is shared by a gentleman in his late 30s with three small children and a wife. He describes a tragic story that provided the audience a chilling account of his struggles. He is dying of terminal brain cancer, and found out shortly after starting a new job. At the time of the discovery, he and his family were covered by COBBRA (an interim/temporary insurance policy). Without treatment he had 3 to 6 months to live; with treatment, he could potential live well over a year. His illness necessitates that he not have a lapse in coverage. While healthcare reform will make it possible for people deemed “high risk” to receive healthcare for pre-existing conditions the recipient must be uninsured for six months, time the speaker does not have to give. He did eventually find coverage but was devastated by the amount of time he had to dedicate to procuring insurance.

All forums are archived at the Cleveland State site. Carrie Haughawout of the Ohio Department of Insurance provided her contact information and encouraged people to provide her with questions and feed back in regards to Healthcare reform. NEOCH is currently surveying homeless people about their experiences with the health care system. NEOCH staff plan on sending Ms. Haughawout the result of our homeless healthcare survey to keep this state office abreast of the challenges homeless people face when accessing healthcare.

by Holly Lyon
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Health Care Forum

Universal Health Care Action Network Introduces Series on Health Care Issues in Ohio

WEDNESDAY, MAY 18, 2011
4:00 to 6:00 p.m.
Levin College of Urban Affairs
Glickman-Miller Hall
Roberta Steinbacher Atrium
1717 Euclid Avenue
REGISTER NOW
Free and open to the public.
Please register at
www.urban.csuohio.edu/forum
or by calling 216.523.7330.

ABOUT THIS FORUM
This forum, entitled “National Health Care Reform: The Ohio Story,” provides a unique opportunity to learn how health care reform will affect consumers, small businesses, insurers and health care providers in the state of Ohio. Following a short video greeting by Senator Sherrod Brown, Carrie Haughawout from the Ohio Department of Insurance will kick off the program with an update on what the state is doing under health care reform. A panel of experts will then offer their individual perspectives about the effects of the changes. The forum will conclude with an open dialogue between the panelists and participants, who will be invited to ask questions and share their concerns.

FEATURED GUESTS
• Diane Suchetka, Medical
Reporter for The Plain Dealer

• Carrie Haughawout, Assistant
Director for Health Policy for
the Ohio Department of
Insurance

• Steve Millard, President and
Executive Director of Council of
Smaller Enterprises (COSE)

• Kathleen Gmeiner, Project
Director, UHCAN Ohio

• Lee Kamps, independent
insurance representative

• Consumer advocates Colleen
Clark and Fernie Legat

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Stand Down 2010

Images from the 2011 Stand Down at the Masonic Temple on February 18, 2011 in Cleveland Ohio.

Another wonderful event staged by InterAct Cleveland. We estimated 550 people attended the health fair on Friday. There were a couple hundred volunteers who helped with food, distribution of hygiene kits, and hospitality, also the Cleveland Photography group provided amazing portraits to around 100 people. The Cosgrove staff served a great lunch. Luke, our staff assigned to the event, wanted to highlight the hand and arm massages that had a long line throughout the day. He also wanted to mention Youthability and their lovable pooches, but I have no idea what that means.

There were health screenings, access to social service providers, and entertainment for the population. This is a relaxing day for those who struggle every day to try to find a stable place to live everyday, and the weary who have endured a tough winter.

Brian
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Take A Bottle of Water To Work Week

Water Needed Downtown

Your assignment for this incredibly hot week is to help out a friend with a bottle of water. Tonight and all this week put a plastic bottle of water in the freezer. Take it out on your way to work and give it to someone sitting or sleeping downtown. Even that annoying panhandler will appreciate a bottle of water especially with some ice in it. Water can be a life saver for the men and women who stay outside.

If you are not comfortable approaching someone on the streets, drop bottled water or even gallons of water at the NEOCH, Care Alliance, Volunteers of America, West Side Catholic or 2100 Lakeside shelter offices. We can all use water during the summer, and we will get it to the people most in need. To find one of these facilities go to the First Call for Help website. They all ring the downtown, and they are probably on your way into work. But to make thing easy, if you work downtown you can just drop the water bottle in a homeless individuals cart or bag. My experience is that we typically have as many homeless people die of heat exhaustion as we have die of hypothermia in Cleveland.

Please keep your fellow citizens in mind this week as you go downtown. Water is a great way to make a difference in another person's life.

Brian
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Time for the Thank Yous

First Step to Universal Health Care

The Northeast Ohio Coalition for the Homeless has always advocated for Universal access to quality health care as one of the solutions to homelessness. We could significantly reduce the homeless population if there was a better health care system including prevention, drug treatment, mental health and management of long term chronic health conditions for those who are poor. The United States took the first step toward this objective on Sunday with the passage of the health care reform bill. This is not what many advocates wanted, but it is a step forward. It is not public health care, but it is certainly better than we have now.

It is time to reach out to your elected officials and thank them for their vote on Sunday. The staff at the local district offices of your Congressional member need to hear some positive words. I have heard that Congressman's Kucinich's staff have had to endure some of the most horrible hate from the callers and visitors over the last week. For those who support health care reform, you should reach out to Congressman Ryan, Fudge, Boccieri, Kaptur, Sutton, and Kucinich to thank them for their courageous vote this weekend. Too often the supporters stay quiet because they are happy with the results or do not have the time, but to provide some balance it is time to thank those who voted for this historic piece of legislation.

Brian
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Don, a Stand Down volunteer who also does speaking engagements for NEOCH is pictured above. The bottom photo shows the crowd toward the beginning of the March 5 at the Cleveland Convention Center. All the red shirted people are volunteers. The Homeless Stand Down could not take place without the hundreds of volunteers. We owe all the volunteers a huge thank you.

Stand Down Details Friday March 5, 2010
Here are some more statistics from the last day of the Stand Down.

Day 3: Friday March 5, 2010 Health Fair

360 guests came through the front doors
409 guests checked in at the front desk.
260 volunteers were present on day three.
36 volunteers who receive services

270 guests enjoyed breakfast

279 guests enjoyed lunch

35 massages were provided

10 Reiki

57 podiatry exams were provided

298 hygiene kits were distributed

5 groups performed live entertainment

7 people were registered to vote

71 social service agencies were available for information

More details soon.

Brian
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Shelter Workers Not Protected

H1N1 (Swine Flu) Planning for Homeless Shelters

I attended the meeting today to talk about plans for a flu outbreak within the shelters in Cleveland. Thanks to Care Alliance and the Office of Homeless Services for coordinating this meeting. I was shocked to learn that shelter workers are not on the list of first immunized with the vaccine when it comes out sometime in October. Shelter staff are not considered emergency front line staff. There may be immunization of shelter workers who are working with children or pregnant women who are high priority for vaccination. This leaves the men's shelters, which are some of the largest facilities in our communities, without coverage for staff. If there is an outbreak of flu, will these workers show up to work? Will they risk their families getting sick if they go to work? It just does not make sense that these 250 to 300 people in the community will not be the first to get the vaccine so that we do not have to close all these shelters. If there is an outbreak and staff stop showing up for work, the shelters will close and these sick people will be sent out into the community. These potentially sick individuals will try to stay with family and friends and risk spreading the illness throughout the community. This is not very good planning to not have these workers healthy and keeping the shelters open. It does us know good to plan and train these staff if they get sick or refuse to show up for work.

Other things I learned today that need some attention:
1. Based on CDC estimates, we will probably see 2 to 4 people die from the flu in our shelters in Cleveland.
2. Because of the high number of smokers and people with compromised immune systems, the homeless population is at especially high risk for both types of flu.
3. We do not have enough hospital masks for staff or those already infected staying in the shelters.
4. There were nine shelters who did not show up for this meeting (which is of some concern).
5. They will set up isolation units within the shelters for those who get sick.
6. The shelters cannot send people out if they have flu within the facility, so this will mean a change in the way shelters operate.
7. There is not much planning going on within the shelters to meet disasters or emergencies in general so this is going to take a lot to get ready in the next few weeks.
8. We do not know if there will be one or two shots for swine flu--this would mean two or three shots are going to be necessary this flu season. One for the regular flu virus and then another series in October for H1N1.
9. Care Alliance is stepping up its regular flu shot routine to cover more people, but the swine flu is the big unknown and a lot of questions remain. We do not know if there is going to be enough vaccine in the local community.
10. There are not a lot of resources right now specific to flu and homeless people on the net or circulating.
11. Shelters have to take people in who show up to the door, but what if they are sick? Do they risk infecting the rest of the population? These are questions that need to be addressed in the near future.

We will continue to track these issues.

Brian
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Updates from Previous Posts

Health Care, Poor People, and Shelter Standards

Today on NPR's Morning Edition they featured a story about health care for homeless people in the context of the current debate about health care reform. I posted something about the need for health care reform to reduce homelessness last week. It was a good story indicating that 70% of the homeless population do not have access to any insurance including Medicare/Medicaid across the United States. I believe that in Cleveland that figure is at 80-85% according to Care Alliance. Single adults in Ohio do not have access to Medicaid and very few are old enough to be eligible for Medicare. This puts pressure on the Free Clinic, Care Alliance, MetroHealth, and the neighborhood family practice clinics to provide charity care to the 16,000-17,000 who find themselves homeless and without health care in Cleveland every year.

I attended the Poor People's March on Friday with about other activists in Cleveland including peace activists, those opposed to poverty, those advocating for universal health care, and unions. It was a nice event well guarded by the Cleveland Police, and they were allowed to walk down the in the street angering motorists this year. I did hear one speaker at the Federal building advocating for straying from MLK's non-violence credo. This was disappointing when viewed with the backdrop of violence displayed at the Town Hall Forums. No politician or elected official showed up.

There are now 23 Cleveland City Council Candidates who have signed onto regulating the shelters. This includes 11 candidates who were in office as City Council members in 2008. If you see any candidates over the next two weeks leading up to the primary ask them about the shelter regulations. We regularly update this site as soon as we hear from the candidates.

Brian
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Question of the Day?

Why is Health Care a Commodity?
photo by Toni Anderson

Why is the health care of my employees and my family at the mercy of an insurance company? Why is anyone allowed to make a profit off of my well being? Why are people so happy with insurance company staff making medical decisions for Americans? Why do we keep paying for health insurance that goes up at 2 or 3 or 4 or even 5 times the inflation rate every year?

There are so many homeless people who do not have any health insurance including Medicaid. There are so many homeless people improperly discharged from hospital to shelter. Most of the homeless population falls through the cracks or they make their medical decisions about which emergency room to go to based on which will not ask them about a previous bill. We need free universal health care in the United States right now! We could significantly reduce homelessness if we could get everyone preventative health care. Those with a mental illness, alcohol or drug addiction or long term chronic health condition would have a significant increase in the quality of their lives if they had better access to a doctor. The Free Clinic, Care Alliance, MetroHealth, and the other neighborhood family practice health facilities do a good job, but the other big players are AWOL in the struggle to improve the health care for homeless people. All of our work would be easier if there was universal Medicare or the Veterans Administration programs were expanded to serve everyone.

Brian
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Grading the Administration 22

Weekly Grades of the Administration on Poverty: B

It is almost time for the Independence Day vacations, and so there was a big push on to get things done. A great deal happened between June 15 and June 21 in the struggle to reduce poverty. Here is a short run down of the items that result in a B on the academic scale:

1. There was more information released about the health care reform efforts. Every week that they push for universal health care guarantees at least a D for the week.
2. The Administration talked about HIV testing, which has not been uttered by a President for 9 years.
   
3. HUD is proposing additional vouchers for those with a disability.
   
4. One negative was the crumbling of the nation's infrastructure with the crash of Metro trains in DC. This is the a sign of the maintenance that has been delayed in nearly every American city for major transportation, utility, and energy projects.
   
5. There was more volunteering by the Administration including an event in Dallas and New Orleans by the Trade Representative and the HUD Secretary.
6. Michelle Obama and the President did another volunteer activity to call attention to the AmeriCorps programs by putting together backpacks.
   
7. There was the announcement of $80 billion in prescription discounts for seniors by the major pharmaceuticals.
8. There were repeated questions for the administration about health care last week including during the press conference.
   
9. The middle class task force met, which normally results in a decrease in points. This week they get a boost because the task force met in Ohio, and our own Amy Hanauer of Policy Matters Ohio spoke to the group. Maybe the middle class task force is not all that bad.
   
10. There was the ABC television special on Health Care reform in which the administration had to defend their choices and the cost of this massive effort to cover everyone.
    
11. There was another push to make sure that no veteran ever becomes homeless with the announcement of the release of more housing vouchers.
12. HHS released a report on the hidden costs of health care last week.
13. Finally, HR 3068 was introduced to put $1 billion into the National Housing Trust in a bill that is being labeled as relief for main street.
    

Brian
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Grading the Administration 20

Weekly Grades for the Administration on Poverty: C-

Twenty weeks for the administration and the grades are slipping from last week. They keep pressing the health care reform with a town hall forum and the announcement that the administration supports a public alternative to insurance companies. These are both positives. They have issued a report on the savings that could be made with medicare and medicaid. One of the interesting items on the White House Blog is four or five stories from real people throughout the United States who are trying to survive during this economic downturn.

There were a few other anti-poverty measures from last week:

1. There were more actions to make government more transparent. They only get a few points for this, because at the same time they were moving to a more open government, the administration decided to fight an attempt to disclose the White House visitor's logs.
2. They nominated a HUD Secretary for Community Planning and Development.
3. The administration gets points off for releasing those questionable job figures last week. We need a government office that can check statistics released by the government like they have in England.
4. The administration did a conference call about possible savings in the Medicaid and Medicare program, but I could not find the results of this call on the site. I know that there are plenty of arguments from the Office of Management and Budget about the crippling costs of health care for the economy.
   
5. Also, last week there was a cabinet meeting and many poverty related issues were discussed.
   

Brian
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Flu Outbreak and Homelessness

Homeless Providers Call for Prevention Efforts to Avoid Swine Flu Spread In Local Homeless Shelters

How do you stay away from those with the flu if you live in a homeless shelter with 40 to 400 other people? The worst fear of all the homeless social service providers in the community is that the latest flu outbreak will materialize in a congregate living facility. The Northeast Ohio Coalition for the Homeless, Care Alliance, and Volunteers of America are asking for donations of hand sanitizer, blankets, bottled water, and tissues to be distributed to the homeless shelters and unsheltered homeless persons to help us prevent the spread of the new strain of flu.

Our efforts will be to collect and distribute these items to all of the shelters in Cuyahoga County. This will help minimize swine flu (2009 H1N1 flu) outbreaks in Northeast Ohio. Often, homeless people do not have access to even the simplest means to prevent them from getting sick. Shelters and homeless programs in many cases cannot afford these items in the quantity needed to contain the spread of this virus.

Swine flu is spread through the air when infected people cough or sneeze. People who are homeless are at higher risk because they come together in large groups for meals and live in group quarters. Many times these facilities are not adequate places to wash hands and it is not always possible for them to “stay at home when they are sick.”

Medication is available to treat swine flu, but it must be taken within 48 hours of symptom onset to be effective. The symptoms include fever, muscle aches, cough, sore throat, headache, and diarrhea or vomiting (or both). Since many homeless people do not have access to timely physician treatment, prevention is vital.

We are urging people to donate hand sanitizers, tissues, water, and blankets to the Volunteers of America Shelter on Walton Ave. (2710 Walton Ave) in the Clark Fulton neighborhood. The Homeless Coalition and Care Alliance will work to distribute these items to all of the shelters locally. We need 750 to 1,000 boxes of tissue and hand sanitizer to distribute to all of the shelters over the next month.

For more information, contact Brian Davis of NEOCH at 216/432-0540. To contact Care Alliance (Cleveland’s Health Care for the Homeless) call Donna Kelly at 216/924-0275. To contact the Volunteers of America call Martin Williams at 216/621-0120

For More Information call:

Brian Davis at NEOCH, 216/432-0540

Donna Kelly at Care Alliance 216/781-6228

Martin Williams at Volunteers of America 216/621-0120

Brian Davis
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Grading the Administration 11

Weekly Grades for the Obama Administration on Poverty: D

This was a rough week to give a score, because nearly all the work of the administration involved international and foreign policy. I had to dig deep to find anything that had to do with poverty coming out of the executive branch this week. I would give an Incomplete for lack of any work done, but the administration is bigger then just the President. So, I looked at what the various departments are doing and found a few things that will help, but it is scarce. This week we have to give the Administration a D for their work on poverty.

The G-20 did approve a large allocation to fight poverty in developing countries. How can we get Detroit and Cleveland to qualify as a developing nation? The department of Health and Human Services is sending out billions to improve Head Start. This is no doubt a program that helps lower income children with proven success. They are also announcing the increase in rural health clinics as part of the stimulus bill. Again, a needed expansion in a country that has developed a formula for converting a person's health to a dollar figure. There will be a series of health care reform forums and the administration is looking for input. Finally, the Department of Education is starting to send some of the capital dollars out to improve schools throughout the United States. That is all that I could find for this last week. Obama was traveling most of the week, and said very little about poverty back home.

Brian