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By Madolyn Bowman Rogers

STANFORD, Calif. — Palo Alto is one of the wealthiest cities in the country, yet homeless people here are twice as likely to not get medical care when they need it as homeless people in other parts of the country, according to a new survey of the homeless in the mid-Peninsula area.

“The access to care here is obviously not good,” said Lars Osterberg, MD, MPH, clinical assistant professor of medicine at the Stanford University School of Medicine, physician at the Veterans Affairs Palo Alto Health Care System and an author of the study appearing in the November issue of the Journal of Health Care for the Poor and Underserved.

Osterberg and co-author Don Barr, MD, PhD, physician and professor of sociology at Stanford, designed the survey to find out the needs of the local homeless population. They conducted face-to-face interviews in 2005 with 145 homeless adults in the area from Redwood City to East Palo Alto. They then compared the results to a national survey of homeless service centers by the Urban Institute.

They found that the mid-Peninsula homeless community reflected the surrounding community. Half of the homeless had lived in the area for 20 years or more, and were more educated than homeless people in other parts of the country. Half had education past high school, and more than 20 people had college degrees. More than one-quarter were veterans.

Many of the homeless had previously been quite successful, including businessmen and a Stanford professor. Thirty percent of the women were homeless because of domestic violence. “What woke me up were all the different walks of life who have become homeless,” said Osterberg.

The survey revealed that the greatest unmet need of the local homeless population was medical care, particularly psychiatric care. Overall, 56 percent said they couldn’t get health care in the last year, compared with 24 percent of the homeless nationwide. More than half of those surveyed had a mental illness. Almost half had untreated dental disease. Although there are some free clinics in the area, limited hours or distant locations make them difficult for the homeless to use.

Hunger was less of a problem here than it is nationally. A kitchen is always open somewhere in the local area, Barr said.

When asked about problems they experience, three-quarters of the respondents cited finding work as a challenge. One man told Osterberg about his struggles in looking for work without a phone number for employers to call or a way to keep his work clothes clean. But when the homeless were asked, “What’s the worst part about being homeless?” across the board they replied, “It’s the way people look at you and treat you.”

The survey results influenced the September 2006 founding of the Opportunity Center, a comprehensive housing and service center for the homeless on Encina Avenue in downtown Palo Alto. The center’s 89 apartments have been fully occupied since opening. The center provides daily drop-in services that include showers, lockers for storing possessions and computers for checking e-mail and hunting for jobs.

A crucial feature of the center is the ground-floor clinic that provides free medical and psychiatric services. The clinic has a growing caseload of about 150 patients plus about 75 psychiatric patients, giving many mid-Peninsula homeless a place they can get to when they’re sick.

Many of the center’s occupants had been chronically homeless because of mental illness, but now with housing, psychiatric care and a community environment, they have been able to stabilize, Barr said. He described a woman with a developmental disability who had been on the streets for years and nearly died once in the emergency room. Now living at the center, she is clean, well-clothed, receiving medical care and part of a community that checks on her regularly.

The key to helping the homeless is providing housing first, then treating the mental illness and drug and alcohol problems, Osterberg said.

“There’s research to show if, as a first step, you provide housing, these problems are much more amenable to treatment,” Barr said. “In housing, their lives tend to settle down.”

Despite its successes, the Opportunity Center is now facing a critical funding shortage. Initially county governments provided funding through their health departments, but that support has ceased. The Palo Alto Medical Foundation helps underwrite the free clinic, but not the psychiatric services, which Barr identified as crucial for the success of the center. A private donor recently stepped in to stabilize the center and keep it running, but there is no long-term plan for maintaining operations.

“We still need to answer the question, if these services are so crucial for the community, how is the community going to support them?” Barr asked.

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