Lisa M. Duchon - Families and Their Health Care After Homelessness: Opportunities for Improving Access

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HEALTH CARE POLICY IN THE UNITED STATES

edited by

JOHN G. BRUHN
PENNSYLVANIA STATE
UNIVERSITY-HARRISBURG

Health Care Policy in the United States

John G. Bruhn, editor

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Physician Participation in Medicaid Managed Care

Sunday E. Ubokudom

Healing the Social Body: A Holistic Approach to Public Health Policy

Elizabeth R. Mackenzie

Directing Health Messages toward African Americans: Attitudes toward Health Care and the Mass Media

Judith L . Sylvester

Gender Justice and the Health Care System

Karen L . Baird

Who Cares for Poor People? Physicians, Medicaid, and Marginality

Margaret M . Hynes

Health Care Reform: Policy Innovations at the State Level in the United States

Larry E. Carter

Telemedicine in Hospitals: Issues in Implementation

Sherry Emery

Helping Survivors of Domestic Violence: The Effectiveness of Medical, Mental Health, and Community Services

Judith S. Gordon

Families and Their Health Care after Homelessness: Opportunities for Improving Access

Lisa M . Duchon

FAMILIES AND THEIR HEALTH CARE AFTER HOMELESSNESS

OPPORTUNITIES FOR IMPROVING ACCESS

___________________

LISA M. DUCHON

Copyright 1998 Lisa M. Duchon
All rights reserved

First published by Garland Publishing, Inc.

This edition published 2013 by Routledge

Routledge Taylor & Francis Group 711 Third Avenue New York, NY 10017

Routledge Taylor & Francis Group 2 Park Square, Milton Park Abingdon, Oxon OX14 4RN

Library of Congress Cataloging-in-Publication Data

Duchon, Lisa M.
Families and their health care after homelessness : opportunities for improving access / Lisa M. Duchon.
p. cm. (Health care policy in the United States)
Revision of the author's thesis (Ph. D.)New York University, 1997.
Includes bibliographical references and index.
ISBN 0-8153-3146-0 (alk. paper)
1. Family-Medical carePennsylvaniaPhiladelphia Longitudinal studiesHistory 20th century. 2. Urban poor Medical carePennsylvaniaPhiladelphiaLongitudinal studies History 20th century. 3. Homeless personsMedical care PennsylvaniaPhiladelphiaLongitudinal studiesHistory 20th century. 4. PoorHousingHealth aspectsPennsylvaniaPhiladelphia-Longitudinal studiesHistory 20th century. I. Title. II. Series: Health care policy in the United States (New York, N.Y.)
RA564.9.H63H38 1998
362.10869420974811dc21
98-42309

For Dennis

Contents

Tables and Figures

When I first began my literature review for this research, I was surprised to come across a published dissertation from 1969 titled, Studies in the use of health services by families on welfare, by a doctoral student at the City University of New York. The research was based on a sample of poor mothers in New York City. The results showed that families on welfare used clinic facilities more than private physicians. In contrast, the general population relied primarily on private physicians for medical care. Almost 30 years later, I find myself in the same position of publishing a dissertation on the use of health care services by welfare families in New York City. For the most part, the findings then still hold today. My research is quite different, however, in looking specifically at the effects of homelessness on the use of primary care services.

In 1969, family homelessness was not the social problem it is today. As noted in a sourcebook on homelessness, Today poverty increasingly means the risk of losing ones home, with the marginally housed facing the on-going risk of becoming the literally homeless. This research is unique in examining the utilization of health services of families after most are no longer homeless.

As a student and former practitioner of public administration, I am interested in the role that bureaucracy plays in shaping our understanding of homeless families and families on welfare. Bureaucratic labels are an important means of acquiring access to a variety of services. We would consider all families living in a shelter as homeless, but not all families that are without their own place to live are residing in a shelter, where they may gain access to referrals for extremely scarce housing. Bureaucratic labels tell us who and how many are eligible for services, but not who or how many are in need of assistance. We know very little about formerly homeless families or their use of health services once they are no longer labeled homeless by the bureaucracy that once sheltered them. The findings from this study begin to address this knowledge gap.

On a more personal note, while conducting this study, I faced my own challenges with affordable housing, and access to health care, based on my bureaucratic label as a university doctoral student. I often found myself in disbelief at the thought of life imitating research. It seemed that way when I felt mistreated by the bureaucracy of the universitys health clinic, my only source of health care, and every time I had to moveusually out of one illegal sublet into another. I was moving more often than many of the homeless families in our research study. My primary trade-offs for subletting affordable, rent-stablized apartments were living with pests and plumbing problems, and having to leave at the owners whim. I count my blessings that I have never been without a home in New York City. But my own experiences have given me a deep appreciation for the hundreds of families in our study who experienced homelessness and the disruptions of moving frequently, or struggled to stay in their own place, despite lousy conditions.

My own struggles, I knew all along, were temporary. They only strengthened my resolve to tell the stories in our data. Since finishing my dissertation, I have found stable housing, and now can choose my own physicians through a relatively generous employer health plan. Unfortunately, as the research presented here shows, many poor families continue to face access barriers to health care even after they are no longer homeless.

Yet, by comparing homeless families to poor, housed families, this research also shows their commonality in povertys grip. Compared to the general population, the mothers in our study, mainly black or of Hispanic descent, have high rates of chronic health problems, low educational attainment, poor employment histories, low marriage rates and long-term dependence on public assistance. Although the gap between rich and poor has widened considerably, these statistics arent so different from what Pomeroy reported almost 30 years ago.

The health care system, by contrast, has evolved dramatically in that time. Just in the half-dozen years since I began working on this research study, enormous changes have occurred with the rapid growth in Medicaid managed care across the country and an overhaul of the nations welfare programs. Even the family shelter system in New York City, which previously offered shelterno questions askedhas policies requiring families to demonstrate that they have no other housing options available before they are allowed access to emergency shelter. These policy changes have profound implications for poor families, because they are changing the bureaucratic labels that confer entitlements to health care, housing, and cash assistance.

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