Do you remember when the classic face of the homeless was that of the skid row bum? We all recall the typical character, a down and out male drunkard, living off the city streets. But times have changed, and so has the face of homelessness. Today the population of the homeless includes families with children. Between 2.3 and 3.5 million people, including 1.35 million children, are likely to experience homelessness in a given year in the United States. Although the numbers had been fairly stable over the last decade, our current brutal economy is deepening this devastating and costly national problem.
Homelessness exists throughout Minnesota. However, most homeless people gravitate to the cities because that is where services and shelter programs are most available. On any given night about 9,200 people are homeless, most in Hennepin and Ramsey County. About 38% are children under the age of 17. In fact, in the 2007-2008 school year, six percent of the children attending Minneapolis Public Schools were homeless or “highly mobile” (no permanent address, but living with various family members or friends). Think about this: At some time during that school year, 5,458 Minneapolis children went to school without having a permanent home, up 18.6% from the previous school year! The expense to the school district to support these homeless or precariously housed children as students is staggering, but not as great as the long-term expense to the state as these children grow up educationally deficient and psychologically damaged.
A Mortgage on the Future
In response to the Great Depression, our government set up a series of safety net and social welfare policies designed to address the shortcomings of the free market. These policies did not eliminate homelessness, but they effectively minimized it and sparked the greatest sustained economic growth in our country’s history.
The history of contemporary chronic homelessness that is increasingly evident in our society began in the 1980s. Over the years, our government has appropriated less and less funding to the Department of Housing and Urban Development (HUD) for the development of affordable housing and other housing programs. This has left our nation’s low-income population with far fewer housing options, essentially creating an imbalance in the basic safety net, the ability to earn a wage that sustains a place to call home.
Financially, a low-wage-earning family who pays more than 30% of their income for housing is considered a cost-burdened household and is identified as financially at risk. According to a recent Wilder Foundation report, about 75% of low income households are cost-burdened, compared to 33% of all people in the Twin City seven-county metro region. A cost-burdened family cannot create their own safety net, so they live on the edge, just a paycheck away from financial ruin. A loss of a vehicle needed for transportation to work, a hospitalization for an uninsured illness, or an eviction due to a landlord’s foreclosure can send a family tumbling into homelessness. And the cost to our society to help this family survive through a series of shelters and programs outstrips the cost of simply providing affordable housing options.
So What Can Dentists Do?
I am a practicing dentist who has a deep faith and dedication to working toward a fair economy, primarily through organizing and advocating for affordable housing. Intertwined with my housing work are other critical issues tied to economic justice: access to health care, equal opportunity in education, a living wage, and racial justice. All are part of the vision of economic justice in a fair society.
If an individual cannot afford a basic life-stabilizing home, then how does he or she afford dental care? Obviously, these individuals cannot. School children go without preventive services, adults with chronic pain are treated with repeated antibiotic therapy prescribed by ER physicians, and certain jobs are unobtainable because of an offensive smile. As a profession, do we bear responsibility for the delivery of care to the poor? Are we overlooking innovative solutions for a more cost effective delivery system? Are we perceived as too focused on protecting our profession at the expense of our most vulnerable population?
These questions are not asked in judgment of our profession nor to make you personally uncomfortable. They hopefully will stimulate a dialogue regarding the epidemic of need that exists in our communities at a time when financial crisis is hitting hard for so many. Are there cost-effective innovations to be developed and implemented that could benefit all? A well-devised program with a group of willing volunteers has the potential to initiate change, provide urgent care, and decrease human suffering. Picture yourself actively stepping in to help and connect to those in very great need right here in Minnesota.
Project Homeless Connect: A “Best Practice” Model
Considered a “best practice” among national programs to end homelessness, Project Homeless Connect (PHC) is a bi-annual event co-sponsored by the City of Minneapolis and Hennepin County in partnership with more than 15 types of essential services, along with medical and dental providers, to give care and assistance to homeless adults. As a dentist, you may be astonished to learn that dental care is the third most requested service at these events, with only housing and employment services requested more.
The one-stop shop event is held twice a year in the Minneapolis Convention Center, with the December 2008 event attracting more than 2,000 individuals seeking assistance. Similar events are held in more than 60 sites across our country, mostly in major cities. Minneapolis/Hennepin County held their first event in December of 2005, and Saint Paul/Ramsey followed in 2006. The next event in Minneapolis is scheduled for May 11, 2009, and Saint Paul’s will be held on June 29, 2009.
Outstate areas of Minnesota also hold such events,** including Duluth/St.Louis County (Fall ’09); Rochester/Olmsted County (January 29, 2009); Fargo/Moorhead (January 29, 2009); Alexandria and Aitkin, Carlton, Mille Lacs, Isanti, Kanabec, Pine and Chisago counties (Fall 2009). Red Wing/Goodhue held its first event on November 6, 2008. While the outstate events do not serve populations as large as those in the Twin Cities, dental services are still a top request among those seeking services. Some sites have not been able to provide any dental services, while others provide only emergency dental treatment or exams.
How Does Dentistry Get Done?
The last four events held at the Minneapolis Convention Center included dental services, with each effort becoming more and more productive. On December 8, 2008, a team of 57 dental professionals screened almost 300 homeless adults and treated 97 with urgent dental care. This team included 19 dentists, 20 hygienists, and 18 dental assistants.
How does an empty Minneapolis Convention Center hall morph into a full service dental clinic capable of screening and treating 300 people in one day? That happens thanks to one major team player of this one-day event, Apple Tree Dental, a non-profit whose mission is to improve oral health in the lives of people with special dental access needs who face barriers to care. Apple Tree Dental has been committed to PHC in a big way. The night before these events, three of their delivery trucks roll up to the convention center docks to unload six mobile operatories, six digital X-ray units with laptops, autoclaves, dental instruments, and supplies.
A team of six set up the clinic, where it is secured until the next morning. Not only does Apple Tree Dental provide the clinic equipment,
but their staff plans and manages the operations. With the success of each event, they have increased their level of participation bringing more and more equipment and employees to this incredible service day.
At one of these events an amazing array of professional and student volunteers came together to serve the poor. Four oral surgeons led our extraction services and provided the expertise to bail us out when the situation got tough. Other dentists wrote orders, administered anesthesia, performed exodontias, and oversaw the screening clinic. The Minnesota Dental Hygienists Association and Normandale Community College recruited hygienists who did the screenings, administered anesthesia, took X-rays, provided post-op care, and pitched in wherever needed. Dental assistants kept the operations flowing by assisting all, taking X-rays, sterilizing the instruments, and turning over the operatories. In addition to their time and clinical expertise, some of our volunteers also donated dental supplies used at the event.
But that’s not all. Herzing College had 30 dental hygiene students present with educational table clinics, not just on oral hygiene, but on topics such as diabetes and oral health, pregnancy and oral health, and the importance of preventive services for children. The U of M sent 10 dental hygiene students, who had a table clinic about services at the School of Dentistry. Finally, pre-dental students from the U of M guided the patients through the labyrinth of stations, including one station of Hennepin County employees where dental insurance coverage was verified for all. More than 100 people interacted to coordinate this clinic with professionalism and compassion. This was truly a well-orchestrated day of service to those with the greatest need.
Making It Home
The story is still not complete. Private clinics were recruited to donate clinic hours during the week of this event. Four private practices donated 47 hours of critically needed hygiene and routine care appointments. Bus passes are provided with these appointments. Homeless people were seen in these private offices for scaling and root planing, routine operative, and other basic treatment. Depending upon the prerogative of the private dentist, many of these patients are “adopted” for comprehensive care. NorthPoint Wellness Dental Clinic offered comprehensive care to those who qualified for the highly-sought-after denture voucher. (Funds were available for only 10 vouchers at this event, and they were gone in the first 30 minutes.) Our station for future appointments had to close in the first few hours of our day because all appointments and vouchers were dispersed. Despite all that we were able to provide, the need remains great.
Think About It!
The Community Service Committee of the MDA recommends adding this service project as another professional volunteer opportunity besides our outstanding Give Kids A Smile annual event. But many have stated that we need more than acts of random charity to provide dental care to our low-income population. We need innovative delivery solutions, well-thought-out programs, expansion of providers and non-profits, so that our profession can move into the future with a vision of oral health for all. It is possible.
*Dr. Della Torre is a member of the Minnesota Dental Association’s Community Service Committee and is a private general dentist practicing in Minneapolis.