Articles

A Compassionate and Effective Port in a Storm: The Case for Investing in Medical Respite Care for People Experiencing Homelessness

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…

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2020’s Converging Housing, Health Care, and Racial Inequity Crises

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. 

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The Capitol

A Public Health Lens on Homelessness Exposes Problems with the Trump Administration’s Proposed Approach

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?

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The Aging Homeless Population: Resetting Policy Priorities

National experts have called out the aging of the homeless population as an impending crisis. [1] This demographic shift is happening rapidly, mirroring general population trends. Nationwide, currently half of single homeless adults are aged 50 or older, compared to 11% in 1990. [2] Moreover, according to a white paper prepared by the Corporation for Supportive Housing (CSH) and presented to a New York City coalition studying ways to address the aging of the homeless population, “not only are those on the streets getting older, but their health is deteriorating at rates much faster than the general population.” [3] The paper cites research showing that homeless adults over 50 had a higher prevalence of geriatric conditions than that seen in housed adults 20 years older. [4] Another study showed that older homeless adults were 3.6 times as likely to have a chronic medical condition as homeless adults under 50. [5] Such findings clearly indicate a pressing need for housing and services that specifically address geriatric conditions among older homeless adults living across varied environments. [6]

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Coaching

Coaching can have a profound impact on leadership skills, relationships with staff and board members, overall job satisfaction and work-life balance, confidence, and adaptability.  John Gilvar’s approach to professional and leadership coaching emphasizes the following touchstones:

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Capacity Building for Health and Housing Equity

I started Gilvar Consulting Services to partner with organizations providing health care, housing, and homeless services and help expand their capacity to meet the needs of patients, residents, clients, and the broader community.  I especially wanted GCS to support community partnership development and efforts to bring to scale cross-agency collaborations integrating physical and behavioral health care as well as housing and shelter services.  As the director of large Health Care for the Homeless programs in both Texas and Washington, I developed and managed numerous successful collaborative initiatives with these same goals. I’m now using my strategic planning, advocacy, policy development, and operations management experience in a variety of new ways.

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