Steve is a 35-year-old, single male who lived in a one-bedroom apartment in a safe neighborhood. Steve worked as a maintenance technician for a local mill. Steve’s job provided health insurance and he rarely needed to use it. Steve smoked half a pack of cigarettes each day and drank socially a few times a month.
One afternoon, Steve’s company notified him that it was laying off more than one hundred employees, including him. Though he was devastated about losing his job, Steve was grateful that he had some savings that he could use for rent and other bills, in addition to the unemployment checks he would receive for a few months. For the next six months, Steve searched aggressively for a job but was unable to find one. With his savings depleted, he was not able to make ends meet, and he was evicted from his apartment. His self-esteem plummeted and he became depressed.
Steve stayed with various family members and friends and was able to pick up some odd jobs to make some money. However, his drinking and anger got worse and his hosts asked him to leave. When he ran out of people to call, he started sleeping at the park. One night when Steve was drunk, he fell and cut his shin. The injury became red and filled with pus. Steve was embarrassed about his situation and didn’t want anyone to see him. But when he developed a fever and pain, he decided to walk to the nearest emergency department. He saw a provider who diagnosed him with cellulitis, a common but potentially serious bacterial skin infection, and gave him a copy of the patient instructions that read “discharge to home” and a prescription for antibiotics. Steve could not afford the entire prescription, but he was able to purchase half the tablets.
Steve began staying at a shelter. Each morning he had to leave the shelter by 6 am, and he walked the streets during the day and panhandled for money to buy alcohol. One day two men jumped Steve, kicked him repeatedly, and stole his backpack. A bystander called 911 and he was taken to the same emergency department where he had sought treatment for the shin injury. Again, the providers didn’t screen him for homelessness, and he was discharged back to “home.”
A few days later, an outreach team from a local nonprofit organization introduced themselves to Steve and asked if he was ok. He did not engage in conversation with them. They offered him a sandwich, a drink, and a blanket, which he took without making eye contact. The outreach team visited him over the next several days and noticed his shortness of breath and the cut on his leg.
After a couple of weeks, Steve began to trust the outreach team and agreed to go to the organization’s medical clinic. The clinic provided primary care and behavioral health services through scheduled and walk-in appointments. Steve said the providers there treated him like a real person. He was able to have regular appointments with a therapist and began working on his depression and substance abuse. A year later, his health has improved. He is sober and working with a case manager to find housing.
What events in Steve’s life created a downward spiral into homelessness? Which events are related to social needs and which could healthcare have addressed?
What were some of the barriers Steve faced in accessing healthcare?
Why do you think the emergency department was the first place Steve thought to go for care? How might the emergency department improve care for patients like Steve?
What public health programs would be of the best utilization for Steve?
