Homelessness: The Invisible Epidemic

A couple of years ago at The Revolution, I wrote about accusations that some hospitals in Los Angeles had been dumping indigent and homeless patients on Skid Row but couldn’t be charged with anything because it wasn’t actually a crime to do that. Yesterday, a bill was introduced in the California State Senate that would require hospitals to discharge homeless patients to any place they designate as “home”.

For a year, reports have surfaced that hospitals here have left homeless patients on downtown streets, including a paraplegic man wearing a hospital gown and colostomy bag who witnesses say pulled himself through the streets with a plastic bag of his belongings held in his teeth.

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Advocates for the homeless said it was common in many cities for homeless people still requiring medical treatment to end up on the street or at the doors of shelters ill prepared for their medical needs.

“Hospitals don’t know what to do with them, and they think it’s the homeless agencies’ responsibility,” said Michael Stoops, executive director of the National Coalition for the Homeless, a Washington advocacy group.

Mr. Stoops said local and federal laws were murky, at best, over where homeless patients should be discharged.

The proposed California law, written by members of Mr. Delgadillo’s staff and introduced by Senator Gilbert A. Cedillo, a Democrat from Los Angeles, would require hospitals to transport discharged patients to their residence or, if they lack one, to the place they identify as their home, typically a shelter.

“There currently is no law making dumping homeless hospital patients on Skid Row a crime,” Mr. Delgadillo said Thursday at a news conference. “What we really need is legal clarity that specifically prohibits it.”

This is canary-in-the-coal-mine stuff, to some extent. Though you won’t read it in the press, naturally, the homeless problem has been growing by leaps and bounds the last 6 years. The Bush Administration and the Pub Congress have cut appropriations to homeless shelters every year, and as the burden has devolved onto cities and states already strapped by everything else the Feds have dumped in their laps, hospitals have been too often put in a position where they simply don’t have anywhere to release these patients.

Asked where “home” is, homeless patients will usually identify the shelter where they go the most often for a bed or a meal but many – if not most – of these shelters are overburdened, understaffed, underfunded, and short on bedspace. The intention of the law is honorable but what good is it if the shelter identified by the patient doesn’t have room for them?

I’m not trying to defend this practice by hospitals, but it needs to be understood that they began doing this, to some degree, because they had no choice. LA is not the only city where hospitals dump homeless patients on the street. The shortage of shelter-space has become endemic across the country as the Republics starved the safety net, and hospitals are caught between rising costs and a dominant cultural disinterest in the fate of the poor. They can’t keep homeless patients indefinitely but there often isn’t a shelter with room for them when they’re ready to be discharged.

Dumping them on the street is an odious solution, but this bill isn’t going to help all that much because it isn’t aimed at the core of the problem hospitals are faced with. It isn’t going to create more shelters or make it possible for existing shelters to expand. It isn’t going to fund more bedspace, and it does nothing to attack homelessness itself.

So what is it aimed at? What most such laws are aimed at: making the homeless who have become visible invisible again.

In the last few years, led by the Social Darwinists in charge of the country, cities and states have gotten quite good at passing laws and ordinances that keep the homeless out of sight where normal people don’t have to be discomfitted by them. Not so long ago – until they were caught – Boston was rounding up its homeless population, putting them on buses, and dumping them in New Hampshire.

There’s been a zero tolerance policy toward them: zero tolerance of appropriations applied to the problem and zero tolerance of their physical presence. Faced with their growing numbers, too many localities have been content to focus on getting them out of sight by pushing them into ghettoes or outlying areas and arresting them if they show up downtown. There’s been little or no concerted effort to make a legal space for them to inhabit (the city of Seattle being the only exception I know of).

Hospitals are not responsible for this state of affairs, and hospitals can’t solve it. It’s a national problem created by automation, globalization, an exploding housing market, and a shrinking safety net. Govts, Federal and local, have done almost nothing to encourage developers to build low-cost housing units. Subsidized housing has been cut even as the need has grown. Economic growth – such as it is – has been centered on the low-wage service sector where even if you have a full-time job you don’t make enough money to keep up with rents that are going through the roof. And equally underfunded psych units and de-tox centers have been forced to release patients onto the streets long before they’re ready to be on their own.

Solving the homeless problem is going to require a concentrated effort by everybody involved, and just shoving their heads below the surface where we don’t have to see them isn’t doing anybody any good.

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