News
Page 8
Street Roots • May 20-26, 2016
Street Roots • May 20-26, 2016
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News
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'You can't be well i f you're sleeping on a sidewalk
or in a crowded shelter,' says John Lozier, leader o f the
National Health Care for the Homeless Council
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Art Rios fought the system; now he fights within it
BY AM ANDA WALDROUPE
homeless and housing policy has not softened.
“I’m still radical in those meetings,” he said.
In recognition of the transformative changes in his life
rt Rios has long been a visible member of
and community service, Rios will be awarded the council's
downtown Portland’s homeless population
Ellen Dailey Award on June 1 during the council’s national
anti an outspoken advocate for people
conference in Portland.
experiencing homelessness.
Dailey lived in the Boston area and spent pari of her life
In 2908. he was one of the leaders of the
homeless.
She suffered from numerous health problems
Homeless Liberation Front, a group of homeless
and was passed from doctor to doctor. Her experiences
people who camped, in protest, outside of City Hall
caused Dailey to become an outspoken activist for better
for weeks, asking then-Mayor Tom Potter and the
health
care for homeless people, and she helped found the
City Council to suspend the city’s sit-lie and
council's National Consume! Adxisnry Board. She was
camping ordinances until homeless people could
known for haring a formidable, charismatic presence and is
find housing. He is part of Right 2 Dream Too’s
considered instrumental in helping to create programs that
leadership. During the 2012 Grand Floral Parade,
ensured homeless people could have continuity of care and
he sat down in the middle of the parade route,
timely health care.
holding a sign that said, “Housing Now, Homes
Rios met her twice at the council’s annual conferences.
have Hearts."
“She
was raz/,” lie said, “She told you how it was. But
Art
Rios
is
chairman
of
Central
Previously, he said, his activism had been
she also gave you the tools to fight your own demons and
antagonistic toward the city, the Police Bureau and H h i Coi/fcm s Health Services
Advisory CounnL
told you. ‘You can get through this. You can gel through
the bureaucratic forces that affect homeless
your homelessness.’ She was a very inspirational woman.”
Rios, who spent 25 years of his life homeless and has
Now. he is working within the system.
Rios. 45, serves on numerous boards and committees, including on A overcome drug and alcohol addictions, shares Dailey’s belief that the
best way for policymakers and elected officials to learn about
Home for Everyone’s coordinating board and Central City Concern's
homelessness - and craft better programs and public policy is to
board of directors and its Health Services Advisory Council, which he
listen to homeless people.
chairs. He is also a member of the National Healthcare for the
“We have the chance to educate people about homelessness and
Homeless Council's National Consumer Advisory Board.
health care ... and teach people about drug addiction and mental
He says his point of view and desire to see radical change in
illness,” Rios said. “We deal with it on a daily basis.”
STAI I W K I II R
BY AMANDA WALDROUPE
John Lozier: It was an important initiative.
The approach evolved from interest in the
Robert Wood Johnson foundation. They
/T " 1 h e fact that safe, stable and affordable
established some demonstration programs that
I housing is an essential factor for a
sought to establish something very simple -
JL person’s good health is increasingly
which was probably a radical idea at the time -
acknowledged among housing and health care
that homeless people can be effectively engaged
providers, policymakers and advocates.
in primary care services. There were 19 original
It is a conviction John Lozier has held for
projects, and we served
decades.
tens of thousands of
Lozier is the founder and executive
people.
director of the National Health Care for
We’ve understood from
the Homeless Council, a national
the beginning that
nonprofit and membership organization
housing is the core
that provides comprehensive health care
problem. Housing is
to homeless people at primary care
health care. You can’t be
clinics the council either established or
well if you’re sleeping on
partners with. On May 31, the council
a sidewalk or in a
will hold its annual national conference
crowded shelter. One of
in Portland.
the main things that has
The council was founded in 1986 and
happened is that we have
since then, its network has grown to
refined those
include more than 10,000 doctors,
understandings. When we
nurses, social workers and advocates.
"O ur economy treats think about violence, we
The council provides support, training
think about trauma and
housing and health
and mentoring to more than 200 public
trauma-informed care.
health centers and hundreds of
care as commodi?
And
we think about
organizations throughout the country
ties, as things to he
cultural humility, an
that receive grant funding from the
bought or sold fo r
increasingly important
federal government’s Health Care for the
pro fit, not as the
approach to health care
Homeless program.
fundamental human for the homeless.
Encouraging people experiencing
rig h t that we
homelessness to become actively
A.W.: I t seems largely
involved in their health care is one of the understand they are.
accepted that homelessness
council’s most important accomplish
They are necessary
is a public health problem
ments. The council was one of the first
for our s u rv iv a l."
organizations to have a consumer
JOHN LOZIER - not a public safety one,
fo r example. B u t it took a
advisory council; membership is entirely
long time, even, fo r public
made up of homeless people who have
officials a n d the public to
received care at a clinic supported by the
understand how much harm - physical, m ental
council. In its trainings and work with clinicians,
a n d otherwise - can be caused from being unable to
council staff emphasize case management and
get a fu ll night o f sleep.
close relationships between providers that
ensure effective referrals and continuous care.
J.L.: Right Sleep science is another place
It also helps homeless people regain their
where our knowledge base has increased really
sense of humanity, Lozier said.
dramatically in recent years - even more
“It’s a great thing that desperately poor
recently than the awareness about trauma. I
people and their providers are able to work so
think I would have to take issue with
closely and so lovingly together,” he said.
homelessness being a health issue. It’s
Lozier will retire at the end of this year. He
predominantly an economic issue. It has to do
spoke with Street Roots about how providing
with the lack of affordable and appropriate and
health care to homeless people has evolved and
available housing for people, which in turn drives
what still needs to happen to help the country’s
health problems. In 1987, the Institute of
most vulnerable citizens, including creating
Medicine of the National Academy of Sciences
universal care.
published a report called “Homelessness, Health
and Human Needs.”
Amanda Waldroupe: When you started the
It found that there are three relationships
organization, how radical o f a n idea was it to
between homelessness and health. One is that
create a program specifically designed to provide
poor health causes homelessness, for two
health care to homeless people?
reasons. One reason is economic: Most personal
S TA F F W R IT E R
■
and across the country on violence. Almost
everyone on the streets had witnessed violence
in the course of their homelessness.
respect Those two together are what makes the
difference.
A.W.: H ow so?
A.W.: B y involving homeless people so m uch -
a sking fo r their perspective, their input, their
opinions - is to genuinely treat them as h u m a n
beings, som ething I th in k a lot o f people forget
because o f their appearance, because they live
outside.
P H O T O S B Y STEVEN L. W E A V E R , C O U R T E S Y O F T H È N A T IO N A L H EALTH C AR E FOR T H E H O M E LE S S C O U N C IL
Doctor’s counsel patien ts a t H ealth to Hope clinics, a nationw ide project o f the Health Care fo r the
Homeless Council established to provide health care fo r people experiencing homelessness.
bankruptcies are health care bankruptcies. The
other has to do with symptoms of illnesses and
people who get squeezed out of housing.
Secondly, homelessness, in turn, causes more
health issues, with exposure to diseases in
shelters and vermin on the streets and violence
on the streets. And the elements.
The third is that homelessness complicates all
the elements and all the things you need to do to
treat people. Add those up, and it’s a major
public health problem.
A.W.: You talked about how o ur understanding
o f the health issues faced by homeless people has
been refined. W hat do you think caused that
refinement o f understanding to take place?
J.L.: Science is part of i t The science has
evolved. That’s not unimportant. Brain
chemistry, neurology, the understanding about
the effects of trauma in particular has gotten
much deeper in the last decade. For us, a more
important part of it has been asking people who
have experienced homelessness to help define
the issues. Our focus oniviolence, for example,
achieved a new clarity for us when the National
Consumer Advisory Board put together a survey
it does for people experiencing homelessness
J.L.: That’s true. Yes. We have tried to involve
our patients at every stage of our work, and that
starts with outreach and really being sensitive to
people’s situations in the exam room. Much
•earlier in our career we talked about what’s now
patient center, self-determination and goal
setting. It goes on arid on to patient satisfaction
surveys to consumer advisory boards, which
operate on a consensus model, so that their
voices carry every bit as much weight as
everybody else’s.
A.W.: I was reading the council’s most recent
quarterly newsletter, I n Focus, about the importance
a n d effectiveness o f case management. The reason
good case m anagem ent is so'effective is that it
creates a one-on-one relationship a n d treats
homeless people with compassion a n d respect.
J.L.: Absolutely. It’s not just compassion. It’s
J.L.: Just feeling sorry for somebody - one
way to express compassion - can be
condescending, for lack of a better word. But
feeling respect for somebody is an expression of
justice. It’s an expression of understanding. It’s
an expression of the quality of all human beings
in the face of our mortality. It’s giving a fellow
human being his or her due.
We’re not about charity. We’re about justice.
Ultimately, that bleeds over to our
understanding of what health care reform still
needs to be. It needs to be universal. At best,
with the Affordable Care Act fully implemented,
there’s still 27 million who are uninsured in this
country. A lot of those will be homeless people
who for one reason or another aren’t eligible or
not enrolled. That goal we set for universal
health care coverage and accessibility to quality
care still remains elusive.
A.W .: You’ve advocated fo r m any years that
housing is a n essential p a r t o f health care, yet the
fu n d in g fo r housing a n d health care are entirely
distinct. How do yo u thin k health care programs,
like hospitals or Medicaid, should use some o f their
fu n d in g to ensure their patients live in affordable
housing?
J.L.: Not enough is happening yet, but we are
beginning to see some glimmers of the
understanding that housing is health care and
that it is a wise health care investment to make
sure that patients are adequately housed. Some
managed care organizations are spending their
money on housing, or a less profound but equally
important intervention like respite care. New
York state is beginning to spend some of its
Medicaid dollars. The problem is that we have
siloed social and health needs apart from each
other in the major federal streams, HUD
(Department of Housing and Urban
Development) and HHS (Department of Health
and Human Services) spend money on very
different things, A lot of people have tried to put
those together at the local level. We need to get
out of the silos and understand that housing is
health care, and that if we want a healthy
population, make sure that it is adequately
housed.
A.W.: There are a t least two competing values
fo r delivering good a n d effective health care. One is
doing it ou t o f the k in d o f compassion y o u ’re
talking about. B u t health reform has generated a
lot o f conversations about creating health care
programs that are “evidence based” or have
See HEALTH, page 10