The Minnesota Department of Health (MDH) recently partnered with the Hennepin Healthcare Research Institute for the first ever state homeless mortality study. Using information from several state sources, the study brought together statistics reflecting Minnesota’s unhoused communities between 2017 and 2021. During that five-year period:
- A Minnesotan experiencing homelessness was three times more likely to die than someone from Minnesota’s general population.
- Unhoused Native Americans in Minnesota had a mortality rate five times that of Minnesotans as a whole.
- A homeless 20-year-old had about the same mortality risk as the average Minnesotan 50-year-old.
- Even through the height of the COVID-19 pandemic, more than a third of deaths among Minnesota’s unhoused during that time were related to substance use – making it the leading cause.
- Minnesotans experiencing homelessness had a 10 times higher risk of death related to substance use than the average Minnesotan.
It’s a stark reminder of the health care crisis that still faces the unhoused of Minnesota. It also serves an opportunity to reflect on what is preventing Minnesota’s unhoused from getting the care they need to stay alive.
In this episode of Off the Charts, we talk with two experts from Healthcare for the Homeless: Kat Donnelly, a family nurse practitioner with Minnesota Community Care, and Josh Leopold, a senior advisor on health, homelessness and housing for MDH. Together, they discuss the needs of Minnesota’s unhoused population and what health care providers can do to help. Listen to the episode or read the transcript.
Seeing the statistics face to face
For Kat, a nurse that works with the unsheltered community in Ramsey County, the study’s alarming findings are not surprising. She’s seen how being homeless can prematurely age someone by 20 to 30 years firsthand. “It makes a lot of sense that the things that people go through on a day-to-day basis are incredibly stressful and traumatic,” Kat said. “And that chronic PTSD exacerbates every other health condition that they’re already coping with in addition to not a lot of access to quality food [and rest]. And the environmental challenges of being outside, keeping yourself warm and fed and safe.”
Minnesota’s climate adds to those environmental challenges. In the winter months, nurses like Kat will typically see waves of frostbite in addition to injuries that come from trying to stay warm like burns, carbon monoxide poisoning and smoke inhalation. Hypothermia is also common, especially when temperatures are just above freezing. “It doesn’t feel like you would necessarily need heat. But for hypothermia, in fact, [it’s] one of the most dangerous temperatures because you have this idea that you’re going to be warm and then the sun goes down.”
And while Minnesota’s winters get the most attention, it’s the state’s summers that have Josh’s attention. “I think one of the things I’m concerned about now is more of the extreme heat,” Josh says, something that he feels the state isn’t as well prepared to take on. “We don’t have cooling centers in the same way we have warming centers [in the winter]. So, I think that’s an emerging concern.”
The barriers to care
While the urgent health care needs of Minnesota’s unhoused are many, there’s a growing feeling that the underlying issues behind those needs aren’t being addressed by health care providers. “I think … there are a lot of [unhoused] people who are very reluctant to come in to get care because of past experiences, and there’s a lot of wariness of the medical profession,” Josh says.
Much of that can be linked to a feeling of power imbalance between unhoused patients and providers. As Josh says, “I think when [they] come in, they kind of have their backs up to anything that’s any kind of perceived slight or sign of disrespect. And so I think there are some things that, from the provider perspective, you wouldn’t think twice about in terms of policies or language used that [would upset] somebody who’s experiencing homelessness.” Those slights can deeply affect someone for years, even decades – keeping them from seeing a health care provider when they need it most.
Also, like many different communities in Minnesota, the unhoused population regularly faces tough decisions that push non-emergency health care into the background. As Kat says, “When people are focused on surviving day-to-day, putting things off for a long time in terms of their health is the norm.” So, when a health care provider asks what took them so long to come in, it can be off-putting. “I’m trying to stay alive, because if I leave my tent, my things are stolen. Because if I leave my partner, they’re vulnerable. If I leave my pet, they’re vulnerable. It’s hard to explain to someone.”
Taking the next steps
Addressing the issues facing Minnesota’s unhoused is only the first step. Finding effective solutions will take time in the field, in clinics and in creating policy. But there are actions that providers can take right now to move in a positive direction. Josh says that an important next step is “training health care providers, doctors and clinicians about how to provide empathetic, patient-centered care for people experiencing homelessness.” Sensitivity from health care providers through a judgment-free approach can help welcome unhoused patients and create trust through positive experiences.
In addition to provider education, the creation of community provider networks can also help reduce mortality rates. According to Kat, “One of the best things about our job right now has been community partners.” By working closely with other agencies that do unsheltered outreach, they can share info and travel to help people they may have treated in the past that are now in other areas.
Josh also notes, “One of the things we’ve seen that I think really accelerated with COVID is this growth in mobile medical providers and backpack, street-based medicine.” There’s been a recent effort to bring together these providers across the state “to get a better sense of what they’re doing, who’s doing what and where we can be making connections, where we can be supporting those kinds of efforts for the long term because we know it’s very difficult when you’re homeless to schedule [and make] an appointment. So whatever care that we can be providing out in the community is going to go a long way, especially preventive care and then just focusing [on what we find]. It is not going to replace the need for specialty care, but whatever we can be doing out in the community, I think is going to be really beneficial.”
To hear more from Kat and Josh, including Kat’s career journey from working in physics to becoming a wilderness EMT, as well as how Josh’s public service path led him from Washington, D.C., to St. Paul, listen to this episode of Off the Charts.
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