Advice for medical students pushing for change in health care for the homeless

Often the biggest challenge facing homeless people after hospitalization is simply having a place to rest and recover. There are some programs that address this problem by combining clean and safe spaces with essential support services such as case management and nursing services. Unfortunately, these programs often face political, financial and social obstacles.

An educational session recorded for the 2022 AMA Annual Meeting explores what is so important about medical sabbatical programs, as well as what medical students can do to promote their acceptance and efficacy.

The session was sponsored by the AMA Medical Student Section, the Association’s representative body for medical student needs and issues.

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Medical respite programs are post-acute places for homeless people “who no longer need to be in a hospital but don’t have a place to rest and recover like you and I would,” said Barbara DiPietro, Ph.D. senior director of policy at the National Council on Homeless Health. Such programs “offer a residential component for short-term recovery after hospitalization for those who do not require a higher level of care, such as skilled nursing.”

Part of what informs respite care is that much of medical training doesn’t include caring for people without housing, said David Munson, MD, medical director of the street team at the Boston Homeless Health Program.

“People don’t realize — they don’t appreciate — the trauma that patients have gone through,” Dr. Munson said. “Respite programs are beautiful in that the care is delivered by people who are really passionate and interested in this work and understand it. You can create an environment where people who are not comfortable in hospitals, who have unscheduled discharges all the time from hospitals, really settle in and feel comfortable in a medical respite program.”

Still, there are many obstacles to the widespread adoption of medical respite care, including stigma, DiPietro said. If you ask around, “you’ll be told at least 12 different reasons why this isn’t a population worth your time or our money or our resources or, or, or…”

As part of a broader policy to end homelessness, the AMA promotes research on the financing, implementation, and standardized evaluation of respite care for the homeless. Learn more about the AMA’s policy on ending homelessness.

Explore the AMA’s Center for Health Equity and the AMA’s Strategic Plan for Embedding Racial Equity and Advancing Health Equity.

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Medical students are in a special position to drive the adoption of medical vacation programs through their idealism and also their passion for the medical profession.

“The No. 1 thing you can do is use your privilege and use your trust,” DiPietro said, noting that medical professionals will listen to medical students in a way that others may not. “We need a value structure in medicine that really pushes the boundaries of where all these blind spots are consciously created, and they also consciously need to be removed.”

The second is to become familiar with evidence-based models to refer to, such as trauma-informed care, said David Woody III, PhD, LCSW-S, president and CEO of The Bridge Homeless Recovery Center in Dallas. These include communication patterns.

“Things go a lot better when you see your patient actively engaged in understanding what’s going on and understanding how they can possibly own part of their healing experience,” Woody said.

The third is to get out of the classroom and learn who is caring for homeless people in your community.

“Someone does at some level,” Dr. Munson said. “Ask around and then go out and spend some time with these people. Watch them and see what it’s like to care for someone after being discharged from hospital when they are on 12 meds and come back to the shelter and still have a wound. Hang out on the street.

Read on for other highlights from the 2022 AMA Annual Meeting.

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