Patients experiencing homelessness need most help during COVID-19

Venice Family Clinic leaders have long maintained that the homelessness crisis is, in fact, a health care crisis. And now, in the midst of a global pandemic, the need to address this health care crisis is more important than ever.

The Clinic is answering that call. Los Angeles Mayor Eric Garcetti announced that the city wanted provide 1,000 COVID-19 tests per day specifically for people experiencing homelessness. Venice Family Clinic’s will support that effort. We will also ramp up our homeless outreach efforts, providing medical care at the city’s new shelters, as more temporary housing is being found amid this crisis.

“The importance of getting treatment out to these folks is really highlighted by their very high death rate. They die almost 30 years younger than the rest of us,” said Dr. Coley King, a physician who leads Venice Family Clinic’s Homeless Health Care program. “The fact that we may make it to 80, and they may barely make it to 50 – that’s probably the heavy part of this job and the very difficult part. I’ve known up to 20 patients who died last year, and it’s sad. They’re good folks. We miss them a lot.”

While the number of people experiencing homelessness in Los Angeles County has grown nearly 40% from 2014-2018, deaths among this population rose nearly twice as fast at 76%, according to the Los Angeles County Department of Medical Examiner-Coroner. And the coroner’s office reported that more than 1,000 died in LA County in 2019.

People experiencing homelessness often have more chronic and acute health and medical conditions, making them more susceptible to the effects of a virus such as COVID-19.

“Our patients who experience homelessness suffer from a higher prevalence of poorly controlled chronic conditions, whether it’s hypertension, diabetes, or chronic liver disease due to substance use disorder,” said Dr. Despina Kayichian, Venice Family Clinic’s chief medical officer. “So this highlights, unfortunately, the potential worst outcomes from COVID-19 this population could suffer if we don’t immediately take proactive action to mitigate that risk.”

Earlier this week, Los Angeles County Department of Public Health reported nine known cases of coronavirus among this population, a number that’s projected to rise. A recent study by researchers from University of Pennsylvania, UCLA, and Boston University estimates that about 2,600 people experiencing homelessness in the LA area will need to be hospitalized for COVID-19, 900 will require intensive care, and more than 400 could die – overwhelming our hospitals, which are already being stretched thinner by the day.

The Westside of Los Angeles, where Venice Family Clinic operates, is home to a large proportion of these folks. That’s why the Clinic started a program specifically targeted to people experiencing homelessness in the 1980s and today has nine teams dedicated to performing street medicine. Though we, along with our partners St. Joseph’s Center and the People Concern, pulled back on street outreach services a couple of weeks ago out of an abundance of caution, we have regrouped and plan to go back out into the field next week. In the meantime, we have continued providing the full range of primary care to these patients at our Rose Avenue and People Concern Annenberg Access Center, as well as the new A Bridge Home temporary housing in Venice.

“[People experiencing homelessness] may have emotional trauma that leads to distrust. They may fear not being treated with dignity. They may have trouble traveling to a clinic with all their possessions in tow. Without access to a shower or clean clothing, they may expect they will be unwelcome because of their hygiene,” King said. “If we can’t bring care to them, where will they get it?”

One of these patients is someone we’ll call Kate, who suffers from multiple sclerosis. When the Venice Family Clinic street medicine team found her nearly four years ago living on the street, she was partially blind from the MS and also had a mood disorder and extreme body lice. The team learned she had lived a life of poverty without family support for many years.

“The goal of the whole team is to get these patients in to stable housing. But along the way, we really want to get them plugged in to meaningful health care and a good medical home, and get their medical situation stabilized,” King said.

By starting medical treatment on the street, King and his team built trust with Kate, as they do with all their street medicine patients, many of whom then make appointments to receive further medical treatment at the Clinic’s flagship Rose Avenue facility. King connected Kate to a neurologist at the Clinic to treat her MS, and she is now housed, but she is not always able to come in to a clinic for care, due to mental health issues. That’s not a problem for King and his team, who visit her at home to help her medically and with case management, including making sure she does everything she needs to do to keep her Medi-Cal coverage.

“She needed to be seen on the street first, or she would have never gotten into care,” King said.

People like Kate, who have underlying medical conditions, are especially vulnerable to coronavirus, not only from a medical standpoint but also from a housing perspective. Those living on the streets don’t have the luxury of staying at least six feet away from others, especially if they live in an encampment or are staying in a shelter. They don’t have the benefit of being “safer at home” when there is no clean, warm home to go to. Many may feel even more isolated than before, as they don’t have family or social networks to rely on.

Support Venice Family Clinic’s medical staff in this important endeavor today.