Holzmann: No Fixed Abode – Hospice Care for the Homeless

That is what the coroner’s office calls it when they are determining the residency of a homeless person who has died. Recently, the Los Angeles Times published an article one of the grim statistics of their homeless crisis. Three people die every day of the year on the streets of LA County. Here in Orange County over 250 homeless persons died with no fixed abode last year.

Our hospitals and jails, a revolving door for those homeless with catastrophic illness, perform triage and release the least unwell. When they have a terminal illness, they spend their last days alone in a hospital bed or on the street. They die alone. It is a terrible tragedy. From 2014-2018 one hundred and forty-four homeless individuals died of cardiovascular disease alone in Orange County. Other illnesses included diabetes, cancer, emphysema, and liver disease; the diseases of the street and of the poor.

It is death without dignity and without compassion. It is a black stain on our society.

In addition, the cost of dying is high. Whether it is the repeated hospital visits as the disease takes over; the ambulance calls; the first responder costs, or the intensive care costs at the end of life we can offer community, companionship and compassion and do it more effectively in a residential setting.

There are already quite a number of hospices in Orange County. It is a profitable business if you have commercial insurance or the family can pay. But if you’re homeless there are no places to go.

In fact, there are at present only two places in the entire country with more than 20 beds for the homeless along with a few private homes that will take homeless people in in their last days. People who may have cooccurring disorders such as mental illnesses or substance abuse. Or maybe just people down on their luck.

We can fix this. There is a path forward and others to help us by lending their experience and expertise. It wouldn’t cost a fortune and there are many who would volunteer. St. Mother Teresa showed us the way. It doesn’t have to be fancy. It has to be welcoming and it has to care for the room and board of its residents. Medicare and Medi Cal already pay for the care costs.

It is an idea whose time has come. As we address the whole person; as we implement a public health model for mental health illnesses and substance abuse it is an urgent need that we can come together around. Let’s all take part for their sake.

Matthew Holzmann is an executive in the electronics manufacturing industry and advocate for issues related to mental health and homelessness. He is a board member of the Orange County Mental Health Board and NAMI Orange County.

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