USA healthcare... what happens to homeless diabectics?

Ok, I understand that everyone gets access to emergency room treatment, but how does our system deal with homeless diabectics? Do they just have to keep going to the emergency room over and over and over again to get insulin?

I am not diabetic or homeless but it works out basically the same way that poor people get things like expensive cancer treatments. There are state hospitals, research studies, free clinics, and doctors willing to do free work in most areas. The resources are there if you know how to figure out the system but that can be a major problem for people with mental illness and substance abuse issues. They can use emergency rooms as much as they want for free because there is nothing to take and (hopefully) someone there like a doctor or nurse will give them advice on how to maintain their health with the resources available. It certainly isn’t ideal but it can be done even for the poorest of the poor. The biggest downside is that they may have to get really, really sick before they get serious medical attention.

he dies, we forget about him and go on with our lives sipping our bottled water and driving our hummers till we fall into a similar fate our outlast the system.

Being a Type I diabetic, I’ve wondered this myself before. I have gotten a free sample of insulin from my primary care physician before, after I complained to her about my high co-pay and the fact that I was rationing my insulin so I could better afford it. But obviously that’s probably not much help to a homeless diabetic.

Most insulin companies have programs to supply insulin to low-income people for free. Of course, I’m not sure how that works if you don’t have an address to send it to.

But even if a homeless person can get insulin for free, that doesn’t really deal with all the issues. Insulin is sensitive, and high or low temperatures will kill it.

Also not mentioned is the glucose testing. If you’re on insulin, you want to be testing your sugars at least a few times a day. Those #@$#@ test strips can cost as much or more than insulin itself.

And then all the associated materials - syringes, needles, etc.

Diabetes is expensive. I think ascensions might be right.

If you are poor enough to be homeless by necessity, you may be poor enough to qualify for Medicaid. Or you may be disabled enough to qualify for Medicare. Either of those functions as reasonable insurance plan, although of course at that level of poverty I’m sure issues of getting enough supplies and medicine still crop up. Then free clinics/ community health centers would also come into play, and even more so for someone neither poor nor disabled enough for one of those types of coverage.

From what I’ve seen when I worked with homeless years ago, the Salvation Army is the key source, at least in Chicago it is or was.

They are excellent at getting people medical help, but in case like diabetes it’s pretty hopeless because you need weeks if not months to get a person stable.

In reality they just keep getting worse, till they are jailed, where they can get some medical help or just die or in a few cases get back on track.

As for medicaid, as a single male, there is almost no way you’ll ever qualify for medicare or even food stamps. For instance, in Illinois you’ll get a card but then the next month they’ll throw you off because you should have gotten a job. If you’re homeless it’s hard to get or hold a job.

Your best bet is Social Security Disablity, but even then it’s hard to get on it, unless you’re working with some organization like the Salvation.

If you’re a woman it’s a bit easier. I had a friend and everytime she wanted something done, she’d go to the public health dept of Chicago and say she was pregnant. They’d give her what ever. I remember she got a ganglion cyst removed because she said she was “pregnant,” and the agencies give top priority to expectant mothers.

Once she got the cyst removed she said “You know what I guess I wasn’t pregnant.”

So women have it a bit easier as they can claim they are pregnant and by the time the test comes back negative, they can get treated for most other things.

Really? Damn. That sucks.

A pregnancy test takes 5 minutes. I have a hard time believing that they’d take her on her word like that.

I think it would depend on what kind of homelessness you’re talking about and the reasons behind it.

Someone who has lost their job and has no resources and family and is staying in a shelter by night, doing day labor or trying to find work or working a low-paying job by day could ostensibly manage with a bit of help from the shelter and by getting medical care via various community health clinics that prioritize treating chronic illnesses like diabetes, especially for the insulin-dependent. (Not all diabetics require insulin.)

Someone who is living largely on the streets with no or only occasional shelter stays with no prospects for work because of unchecked addiction issues or mental illness (or both) who develops diabetes is, indeed, likely to become very very ill. If found in a diabetic crisis and transported to a hospital in time, they may be able to engage all of the different aspects of medical care that they’d need to save their lives, but the long-term prospects seem dim.

To add to what ascension says, if his diabetes goes unchecked and is severe enough, before he dies, he bounces in and out of the ED for episodes of diabetic ketoacidosis (severe electrolyte abnormalities secondary to extremely high blood glucose) and/or severe MRSA cellulitis/abscesses because he has peripheral neuropathy (can’t feel his legs very well) and is prone to infections anyway d/t the diabetes, costing our health care system tens of thousands for ICU stays while he suffers, and possibly loses limbs and/or his sight. Then he dies, from sepsis from one of his leg infections (especially if he delays going to the ED), or kidney failure from long-term elevated glucose, or heart disease, or acute heart failure from severe diabetic ketoacidosis. That is, unless he is mentally well and socially stable enough to find the resources to help him manage his diabetes.

Hospitals are required by law to provide emergency care to the point of stabilization (which could mean days to weeks in the ICU) regardless of ability to pay. For actual diabetes management counseling/support/medical supervision, you have to rely on charity – free clinics, medicine giveaway programs, etc., but as mentioned above there are many obstacles to accessing care, and you need consistent care to successfully get a newly diagnosed, uncontrolled diabetic on to the right program for their body, which is likely to be more than the homeless are able to scrounge together from free sources.