Vulnerable, low-income populations in need of social services visit the emergency room at more than twice the rates of other Americans. But once treated and discharged, they face another barrier to staying healthy when they return home: keeping their utilities on. More than 16 million US households face energy insecurity, meaning that they go without necessary utilities such as heat and electricity, throughout the year.
The reality of poverty is that when forced to balance the necessities of rent, food, health expenses, transportation to work and utilities, electricity and heat often are forced to take a back seat. And going for long stretches of time without those basic needs has serious, and often overlooked, health implications.
To Heat or to Eat?
Being poor often means being cold through the winter months, which can also mean getting, and staying, sick. Besides the extreme discomfort of living in a heatless home, the long stretches of exposure to cold of Americans who cannot afford to heat their homes puts them at higher risks for cardiovascular events like stroke and heart attack, and also in danger of respiratory infections. For the elderly, it’s increased risk of hypothermia. For children with asthma, it’s an exacerbation of their symptoms.
Dark Times for Low-Income
For someone with a brief power outage, being cut-off from their devices can be a reprieve from a fast-paced world. For those who cannot afford to keep them on, it is a depressing, isolating and unhealthy reality, that can cause anxiety and depression. When the power goes out, it leaves residents in darkness with no lights, limited communications, and no electronic appliances. Without electricity, residents forego appliances like refrigerators, which safely store nourishing, perishable foods like fruits and vegetables, limiting their diets to non-perishable, more heavily processed ones. Besides helping residents maintain a healthy diet, refrigerators are also needed to store life-saving medicines that can help sick residents stay alive; antibiotics, insulin, HIV and chemotherapy drugs all require refrigeration.
It’s no wonder that utility support is ranked among the top concerns for patients who screen positive for unmet social needs. While laws are in place in states to protect children, the elderly, and chronically-ill residents from utility shutoff, this provision requires medical documentation from the physician.
Lighting the Way
Healthcare providers at Boston Medical Center found themselves discharging patients who would be heading back to homes with no heat or electricity. In an effort to improve health outcomes for these patients upon discharge, BMC’s legal team worked with physicians to write protection letters that would demonstrate medical need for patients, and prevent their utilities from being shut off. It also helped set up payment plans with utility companies and ensure future shutoff protection. To scale up and benefit more people, BMC integrated a form letter into their EMR’s. This program helps save 600 residents from shutoffs every year.
Programs like Boston Medical Center’s are a perfect marriage of hospital care and population health, in that it addresses interdependence of basic needs and their impact on health. Programs like these are key to addressing the social determinants of health, and striving for greater health equity.