As It Happens

Homelessness as a medical condition? Hawaii doctors could soon prescribe housing

A state senator has drafted a bill that would classify homelessness as a medical condition and allow MDs to write prescriptions for permanent shelter.
In this 2015 photo, a homeless man drinks water while sitting on the beach near Waikiki in Honolulu, Hawaii. (Jae C. Hong/AP)

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Doctors in Hawaii may soon be able to do something more for their homeless patients than simply treat their sickness. They could prescribe housing.

For individuals who come to the hospital 60, 80, 100 times in one year, those bills can be $120,000 or $130,000 ... and we're not making them any better.- Senator Josh Green

A bill that would classify homelessness as a medical condition is making its way through the state legislature. It's the brainchild of Josh Green, a Democratic senator and doctor.

Homeless man Iose Iose, 53, heads towards the encampment where he lives, Feb. 8, 2017, in Honolulu. (Cathy Bussewitz/AP)
He wants physicians to be able to write prescriptions for homes for people who have been living on the streets for longer than six months and who suffer from mental illness or drug addiction.

Senator Green spoke to As It Happens host Carol Off about his proposed law.

Carol Off: Senator Green, why do you think that doctors should be able to write prescriptions for homes?

Josh Green: Well, doctors are very close to the challenges that the homeless population faces. I'm a physician, in addition to serving as a senator, and for years I've been doing my best to take care of people, usually when they come to the ER, but we have a great challenge. We can only put Band-Aids on peoples' problems.

In this 2016 photo, friends Rilly Kenchy, 17, left, and Shai-Ann Barcarse, 14, right, pose outside a new homeless shelter in Honolulu. Both live outdoors nearby with their families. (Cathy Bussewitz/AP)

CO: As a doctor working the emergency room, what did you see that might have inspired this idea?

JG: What I see is very wonderful human beings who are suffering. I see the same people over and over again, the same faces, come to the hospital, to the ER, because they have nowhere else to go ... When you're homeless and you have exposure to the elements and exposure just to the challenges, the existential challenges that occur on the streets, people become frenetic. They get worse and worse with their behavioural health challenges, depression or anxiety grows. A lot of time psychosis develops ... If I can be frank, there is a lot of drug addiction in the population of people who are chronically homeless. So I see those problems, but most of them aren't very treatable in the ER.

Hawaii state Senator Josh Green, who is also a doctor, put forward the new housing bill. (Facebook)

CO: What you're describing is something, in addition to being unfortunate and difficult for homeless people, it's also very expensive to your health care system.

JG: The chronically homeless are the 20 per cent of our homeless population that are having the greatest struggles. They've been homeless the longest and can't break out of the cycle. So I see all of those individuals and then the cost is fairly catastrophic. For individuals who come to the hospital, in some cases, 60, 80, 100 times in one year, those bills can be $120,000 or $130,000 per person per year. So for individuals who are on Medicaid in our state, they're consuming a ton of money and we're not making them any better.

CO: But how do you decide who would qualify for a housing prescription?

Two children rest on a hammock at a homeless encampment in the Kakaako district of Honolulu. Hawaii in 2015. (Jae C. Hong/AP)

JG: It's actually not as difficult as you might think. We are a small state, a small community, and my ER colleagues and I know the very individuals by name that are chronically homeless with this challenge ... I write prescriptions for significant care all the time that cost far more than housing. Now that I'll know the individual, they've been houseless or homeless for more than six months and they have these other conditions, I write the prescription and then it would do what all prescriptions do. It would have to be approved by the insurance company that's covering it and, in this case also, I think, the Department of Human Services, who oversees housing ... We found in Hawaii that health care spending dropped 43 per cent as soon as we got people into stable housing.

Any solution that helps some of our chronically homeless benefits all, benefits society.- Senator Josh Green

CO: But you know that, I'm sure, from talking to social workers and people who work with homeless people, is that there is a percentage of them who, if you give them housing, they will return to the street. That's not the solution for them. They can't cope with that. So how do you do the triage? How do you determine who's going to benefit?

JG: You're right. Not everyone will avail themselves of this program. It might only be half or a third or a quarter of the people that will take this opportunity. But any solution that helps some of our chronically homeless benefits all, benefits society.

This interview has been edited for length and clarity. For more, listen to our full interview with Josh Green.