Transformational change at an organizational or systems level requires both deep listening and the willingness of leaders possessing decision-making authority to collaborate with those most directly impacted by the problems necessitating change. Few leaders I know would dispute this premise in the abstract, but many might struggle to explain in concrete terms how they walk the walk as well as they talk the talk. Moving organizations and communities from words to action around redressing institutionalized racism requires leaders not only to put listening and collaboration skills to the test, but to leap beyond the comfort zone of routine approaches to problem solving. Adaptive leadership and mindful communication practices can provide an excellent platform from which to dive into the deep water of acknowledging racism and other structural forms of oppression as powerful drivers of inequities in the areas of health, housing, and economic advancement.

New COVID-19 hospitalization data shine a stark light on the connection between homelessness and poor health.  The Minnesota Department of Health found that people residing in homeless shelters who were diagnosed with COVID-19 were 4 times more likely to be hospitalized and 3 times more likely to be admitted to an intensive care unit (ICU) than the overall population of Minnesota residents with a COVID+ diagnosis.  The hospitalization and ICU rates for people living unsheltered were even worse:  almost 10 times more likely to be hospitalized and 7 times more likely to receive treatment in an ICU. 

Stories like the one related by Dr. Leslie Enzian during a panel discussion at this month’s annual Washington Conference on Ending Homelessness have helped me appreciate the critical role that medical respite care (aka recuperative care) plays in homeless response systems. Medical Director of Seattle’s Edward Thomas House medical respite program, Dr. Enzian joined Washington Health Care Authority Deputy Chief Medical Officer Dr. Charissa Fotinos, Ben Miksch of United Health Care, and myself to talk about medical respite care’s unique approach and contributions to local COVID-19 responses. We also discussed efforts to bring medical respite care to a scale that can better meet community demand — in Washington and around the country. Early in the discussion, Dr. Enzian described the experience of Edward Thomas himself, the African-American formerly homeless man for whom Seattle’s medical respite care program is named and who granted permission to share his background and path to stability. Depicted in the photo above, Mr. Thomas…

The current pandemic has shined a spotlight on pre-existing structural problems that lie beneath the massive inflow of people into homelessness and how federal policies perpetuate them.  In a brief slide deck, I recently highlighted for Congressman Derek Kilmer how federal labor and housing policies seed homelessness, particularly for Black, Indigenous, and People of Color (BIPOC), making it virtually impossible for many communities, even those with robust homeless services systems, to keep up with the inflow of new people losing their housing and needing shelter and other assistance. 

Moving beyond statements of solidarity to the real work of supporting change

A recent
University of California study titled Health
Conditions Among Unsheltered Adults in the U.S. brings into focus
public policy blind spots that make progress challenging for clinicians and
other professionals working to end homelessness.  Personally, the study’s findings evoke a
question that preoccupied me during my tenure as director of a 10-agency
health care network treating over 21,000 unduplicated homeless individuals
per year: Why do policy debates about homelessness pay such scant attention
to significant health needs that both precipitate the loss of housing and
create daunting obstacles to regaining stability after an individual or family has
become homeless?