Homeless Records are Medical Records

Revised: January 2019

By Sarah Owens and Michael Livingston

20th Century Record Keeping

When the Trump administration announced recently its plan to spend billions to overhaul the Department of Veteran Affairs' electronic medical records system, no one questioned the need for  providers to be able to "trade information seamlessly and...seamlessly execute a shared plan of care with smooth handoffs."

So, one can't help but wonder why the value of sharing information and plans of care for the homeless seems to have been such a hard sell.  Is it because homelessness is somehow a different problem?  Well, yes and no.

It's different in that, historically, homeless services have not been much of a priority -- except perhaps when the homeless were veterans.

It's the same in that, to paraphrase Secretary Shulkin, technological innovation is not a core competency of the average homeless services provider.  

It's also the same in that technology, like everything else, is a resource issue.  When resources are limited, the tendency is to want to focus on "direct services", or what some might call the human side of the equation.  This was likely the situation with the VA, and would be still, but for a new administration deciding things needed to change.  

Sometimes, what appears from the inside to be working fairly well can look pretty ridiculous to someone outside the system.  That's why pressure to change tends to come from outside, or not at all.

Here in the valley, the pressure on homeless services to change has been very low indeed.  For the most part, the emergency shelter and homeless housing programs in Marion and Polk Counties, as in surrounding counties, are of 20th century vintage, meaning they were designed for single adult men with mental and substance abuse disorders, because,  in the 1990s, only 11 percent of the adult homeless population was aged 50 and over.  Providing basic needs for this younger population included treating the aforementioned disorders, traumatic injuries and infections.  The care was mostly short-term.

Today, however, half the adult single homeless population in the US is aged 50 and over.  (The median age single adults in in Marion and Polk Counties is 46.5.)  They have chronic diseases like diabetes and heart and lung disease.  They need to make repeated visits to health care providers and adhere to complicated medication regimens, specific diets and physical routines, which is all but impossible to do while homeless.  Add to that "high rates of cognitive impairment (problems with memory, information processing and following directions), functional impairment (the ability to manage daily tasks such as dressing, bathing, toileting), mobility impairment (the ability to walk), and deteriorating hearing and vision", and the value if not necessity of being able to track and trade information seamlessly among housing and service providers becomes obvious, but only if you're looking at the data.

The most effective homeless housing and services providers collect and share data through a homeless management information system (HMIS).  In Oregon, and in other states across the US, the HMIS application is ServicePoint. 

from the MSI ServicePoint Handbook

Without ServicePoint, providers must rely solely on whatever information their clients are able to provide, and their staff are able to collect.  They work in relative isolation with limited information, and get predictably limited results.  This wouldn't be acceptable in a medical services delivery system, and it shouldn't be acceptable in a homeless services delivery system.