The Finances of Being Homeless and Diabetic

As I have mentioned before, I tend to take care of the patients in the emergency department in waves. Is is the weather? Is it the moon? Who knows. But this past week, I have taken care of three different patients in the past week that are dealing with managing their diabetes while being homeless and without jobs or primary care providers.

So what do they do? For one reason or another, they end up without insulin. In my opinion after watching these patients for some time now, I believe that they come to a place of such depression, completely destitute, that they truly to avoid their problems and do not seek help. Additionally, as their sugar begins to creep higher and higher, I think they begin to feel so ill that they have another reason to feel horrible and not seek additional help.

Anyways, after a few weeks of poor dietary management and no medication, they end up on the doorstep of the emergency department in full-blown diabetic ketoacidosis. And at that point, it becomes much more difficult and complex to treat their issues. And not only is it more complicated financially, it is another notch in their belt towards renal failure and other deadly systemic issues. Another round of DKA is nothing to sneeze at, every trip to the ICU for DKA management is one day closer to dialysis forever and so many other issues.

It is not fiscally responsible for any party for the homeless to slip into DKA.

So what are our options?

This is a two-fold issue, and I will address the shorter issue first.

1) First. Our homeless populations have to step up. They need to address their own health issues. A bystander cannot tell where they are at health-wise. That is an entirely independent act.

I also understand the mental issues that are also present, making being a proactive person challenging. But they really only have two options here: a) seek help and b) die eventually from it.

2) This is where it becomes more complex. If the homeless population is actively seeking insulin and diabetic supplies, where do we send them? Where do we have those free supplies?

Many believe that the emergency room has all of those supplies. We do, to an extent. We can treat their immediate issues, but if they do not have an admitting diagnosis, they don't get to stay with us. And we don't have free supplies to give out once we discharge them from the emergency room.

However, what we do have on weekdays and Saturdays operating during regular business hours, is a social worker. Many people get frustrated that our dear social workers cannot work immediate miracles. But what they can do is provide resources.

Our social workers hand out pages and pages of potential resources. And they don't just limit their resources to the surrounding area, our social workers will even hand out information on other cities or states that have better resources. Perhaps another city or state has a much better free insulin program? She would make sure these patients had that information.


So. A homeless individual is at your ED. They don't need to be admitted, but they do need resources so that this doesn't happen again. What local resources is that social worker going to hand out?

The main place that people that need assistance can find free insulin and diabetes supplies is Ocala's
Interfaith Hope Clinic. Its an amazing institution that really does do God's work for His people.

http://www.ocala.com/news/20161223/interfaith-expands-medication-program

What are the economics of this issue? Well, in some ways its very simple and in some ways it is not.
It is much cheaper to provide insulin supplies for dozens of people, than it is for the government to pay for one person's ICU admission.

So what's at stake? It is remarkably more fiscally responsible to provide supplies at little to no cost for these people than it is to cover an ICU admission when that becomes unavoidable. That is the information that needs to be passed along to potential community stakeholders. What ends up being cheaper ALWAYS? Preventable medicine. Always. Always. Always.

And hopefully this post showed you in just one tiny example just how true that is. We need to believe that because we need to ensure that our stakeholders believe that. Preventative medicine always wins.