This post is part of a collaborative narrative series composed of my writing and Chris Arnade's photos exploring issues of addiction, poverty, prostitution and urban anthropology in Hunts Point, Bronx. For more on the series, look here.
Homelessness is believed to be a cause of health problems and high medical costs, but data supporting this association have been difficult to obtain. We compared lengths of stay and reasons for hospital admission among homeless and other low-income persons in New York City to estimate the hospitalization costs associated with homelessness.
We obtained hospital-discharge data on 18,864 admissions of homeless adults to New York City's public general hospitals (excluding admissions for childbirth) and 383,986 nonmaternity admissions of other low-income adults to all general hospitals in New York City during 1992 and 1993. The differences in length of stay were adjusted for diagnosis-related group, principal diagnosis, selected coexisting illnesses, and demographic characteristics.
Of the admissions of homeless people, 51.5 percent were for treatment of substance abuse or mental illness, as compared with 22.8 percent for the other low-income patients, and another 19.7 percent of the admissions of homeless people were for trauma, respiratory disorders, skin disorders, and infectious diseases (excluding the acquired immunodeficiency syndrome [AIDS]), many of which are potentially preventable medical conditions. For the homeless, 80.6 percent of the admissions involved either a principal or a secondary diagnosis of substance abuse or mental illness — roughly twice the rates for the other patients. The homeless patients stayed 4.1 days, or 36 percent, longer per admission on average than the other patients, even after adjustments were made for differences in the rates of substance abuse and mental illness and other clinical and demographic characteristics. The costs of the additional days per discharge averaged $4,094 for psychiatric patients, $3,370 for patients with AIDS, and $2,414 for all types of patients.
Homelessness is associated with substantial excess costs per hospital stay in New York City. Decisions to fund housing and supportive services for the homeless should take into account the potential of these services to reduce the high costs of hospitalization in this population.¹
In a white room, on a high floor of Lincoln Hospital, a woman with pale skin floats in clear water.
Towels of thin, white gauze lay on the side of a white ceramic bathtub that is extra long, square-shaped and bare: no shower or privacy curtain. A white waste bin with a white step-lid sits next to the bathtub adjacent to one of the white walls. Between the bathtub and the door, two white dressing gowns printed with blue flowers bunch on the white-tiled floor.
One gown covered the woman's front, the other, her back. Later, they will become bathmats, and after, will drape damply on her front and back again.
A cast-aside sock in the corner is yellow, white anti-slip grips on both sides. The other sock plugs the drain as the tub fills. Color looks out of place here.
The room's stark whiteness causes squinting. There are no windows, no mirrors or wall artifacts; looking up, only white fluorescence.
Next to the door, there is a chair with pink padding and wooden structure. It reclines to an angle changing the person seated --nurse, family member -- from aide to viewer: leaning back, legs go apart, and the head rests.
In the tub, the woman faces away from the chair, spigot flowing onto her feet. A white hospital bracelet tethers off the right wrist that bobs in the water. Orange and black bracelets stating medicinal things tangle above it.
There doesn't seem to be any soap. There is nothing for anyone to do without any soap.
Bent knees stick out of the water. Her legs have circle scars where abrasions and abscesses used to be, bruising the color of crushed grapes where veins were, road work of drugs.
Her form, though, is not strange. Under water, her body is grace, touchable. Smooth, supple legs with curved calves and pert breasts. It's unclear what is wrong with her health.
It can be imagined that she suffered an outside trauma that marked her body.
She can't have lived homeless and done heroin for so long, for so many years. She is beautiful.
The woman spreads her legs, raises one to adjust the taps with her toes and the ball of her foot. It's too hot.
Since there is nothing with which to clean her body, she moves water over herself with her hands.
Her hair knots behind the nape of her neck in snarls as she becomes near submerged, strangely un-wet in the full tub.
This is the only place she can obtain comfort, the sole bathtub of the floor's wing. She sneaks to this place without permission, her second bath in two hours.
Too soon, she's done, water still too hot.
As she rises, the skin of her body alters: it sags, creases. Lines of deep white collect on her stomach; features collapse and bloat. Her pain returns.
She stands half in a puddle of water that drips from her body, half on her discarded gown. Hair still un-wet, she looks to the viewer in the chair.
"Can you dry me?"
I kneel down, onto the white and blue flowers.