Understanding the Health Care Access of Homeless Individuals in Honolulu

Homelessness is a growing issue in Honolulu, with an estimated 8,228 visits by 2,850 homeless people in the last full year before the pandemic. This makes Queen's one of the largest providers of homeless services in the state. The health disparities observed in this population are due to various factors, such as barriers to receiving care, barriers to following personal care instructions, and environmental factors, such as adverse weather conditions, risk of trauma, and lack of storage of medications. Studies have revealed that homeless patients face numerous obstacles when it comes to accessing health care.

These include complicated and lengthy registration procedures, long waits, uncomfortable clinical schedules, fear of having their belongings stolen, and lack of money, transportation, and phones. Additionally, they often receive discontinuous care due to their transient lifestyles, lack of service in their living area, and distrust of health care providers. In a housed population, having health insurance is strongly associated with better health and improved access to preventive care. However, only 45% of homeless people in the continental United States claim to have health insurance.

Current research is examining the attitudes of the homeless on O'ahu toward health and health care, self-evaluations of their health, and the level of interest in a subset of possible interventions to improve access to health care. The Queen's Care Coalition employs social workers and health care guides to help homeless people connect to more long-term care at community health clinics and access housing and other services that could prevent them from returning to the emergency room in the future. When a homeless individual is able to access medical care in Honolulu, they often discover that only two out of 100 homeless people identified as the main users of hospital services are in the information system. This would indicate that the health of the homeless population is actually worse than that found in this study.

Furthermore, there is not even a way for doctors to make sure that the homeless people they treat in the emergency room can fill their prescriptions after they're discharged. The CORE program led by the Honolulu Department of Emergency Services sends ambulances with EMT personnel and social workers to respond to calls from homeless people who are not emergency cases. A homeless service worker would call one of the island's community health clinics to arrange for the patient to be treated there immediately. They would also enter the person into the homeless management information system, ensure that their food stamps were up to date, verify that the person is on a housing voucher list, and then upload them to a taxi or other non-emergency mode of transportation to the clinic.

This finding may also indicate a significant increase in the number of homeless people from Micronesia or an immigration of Micronesians who have not found housing. Every day, nearly two dozen homeless people go to a Queen's Health System emergency room for care.