An ounce of prevention is worth a pound of cure

-by Paul Dragon, CVOEO Executive Director

These past months of the pandemic have driven home the point that we can and need to do much better as a society for people who are homeless and living in deep poverty. We understand better than ever that housing, food and a basic income are essential health interventions that keep people alive while avoiding expensive medical procedures and medical settings like the emergency room. We realize that the people who work in shelters and emergency housing facilities across this state play a vital role in medical prevention, medical care and public health, but this is something that the medical community and most of society by and large neglect to acknowledge.
The key difference of course between the medical system and the emergency housing providers is that the vast majority of emergency housing providers are getting low wages, few if any benefits, including access to retirement, while the medical community receives, in general, comparatively strong wages and excellent benefits. The other staggering difference is that many medical interventions, even minor surgeries, can cost well more than one year of subsidized rent for an individual or family experiencing homelessness.
There is also the irony, or rather tragedy, of hospitals prematurely discharging their patients who are homeless to a shelter or emergency housing facility. Many providers around the state are used to people being discharged to their shelter without medicine or in some cases needed medical equipment. A couple of months ago a colleague wrote that a person arrived at their shelter still in hospital scrubs. This is when the emergency housing staff must move from prevention to frontline medical staff administering whatever care they can, including cleaning people who soil themselves, which our staff did on several occasions when we operated the Holiday Inn emergency shelter in South Burlington.
The State can be a wonderful partner for our nonprofit network yet we all need to make some important decisions moving forward. We do not want to go back to the starting block where people who are homeless return to an underfunded shelter system. We know that many of these folks are medically compromised due to unstable housing and traumatized by their experience of homelessness. It’s much better to think about emergency housing in which everyone has their own room and bath, with services on site, where people have the privacy, dignity and support to fulfill their own futures.
Not only do service providers around the state do a significant portion of healthcare prevention, they also provide essential public health services by avoiding public outbreaks that can often start in medically-compromised homeless communities. For example, homeless communities around the country have experienced outbreaks of COVID-19, tuberculosis and hepatitis as well as other transmittable diseases. Emergency housing providers are on the front line ensuring not only the health of the people they serve, but the community as a whole.
It is time for the federal and state governments, and more importantly the medical community, to recognize the role emergency housing providers and other essential services, like nutritious food access, play in medical prevention, medical care and in public health. It is far beyond time to shift some of the medical funding to these essential providers so they can adequately house, feed and care for people while caring for themselves and their families. After all, “[a]n ounce of prevention is worth a pound of cure.”