Where We Stand
Section: Public Health
Policy: Health Care Delivery and Advocacy for Persons Experiencing Homelessness or Houselessness

Health Care Delivery and Advocacy for Persons Experiencing Homelessness or Houselessness

 

Principle 1: Access to high-quality healthcare, independent of housing status or stability, is a fundamental element of a just society in accordance with the OMA’s commitment to providing universal health care. 

Recommendations: 

  1. Acknowledge that Persons Experiencing Homelessness or Houselessness (PEH) represent a unique community in our state with unique needs.  While a diverse community, PEH share commonalities and deserve consistent access to care with a focus on the amelioration of barriers to care. 
  2. Advocate for the highest quality of evidence-based, patient-centered care for PEH both within traditional healthcare settings and through the work of outreach teams. 
  3. Affirm that access to healthcare should not be conditional or dependent on housing stability, substance use, or mental health stability.  
  4. Encourage the delivery of healthcare services despite perceived or actual non-adherence, with attention to maintaining the safety of other patients, staff and clinicians.  
  5. Advocate for collaboration between healthcare organizations and organizations that work directly with PEH.  
  6. Advocate for financial reimbursement for street and shelter-based services among all third-party payers.  

 

Principle 2: The OMA recognizes that social determinants of health negatively and disproportionately impact the health of those living on the streets. Innovative approaches to healthcare delivery and harm reduction may be necessary for the provision of equitable healthcare.  

Recommendations:

  1. Recognize that a Housing First model, where access to permanent housing is not contingent on mandatory therapy or substance use cessation, is an effective, evidence-based approach to improving the lives of PEH. While housing first is ideal, recognize that care can and should be delivered prior to housing stability.  
  2. Advocate for laws and policies that advocate for the creation of affordable, permanent housing, especially units with integrated social services systems and healthcare resources.  
  3. Advocate for laws and policies that protect the rights of PEH. 
  4. Oppose forced relocation (“sweeps”), a dehumanizing process that can lead to the criminalization of non-criminal activities and worsen health outcomes. Advocate for evidence-based approaches. 
  5. Promote the establishment, funding, and review of team-based mobile medical and social-service outreach practices. 
  6. Encourage the development of discharge plans for PEH that are holistic, cost-effective, evidenced-based, and take into account individual barriers to care.  
  7. Advocate for municipal interdisciplinary collaboration and coordination of care for PEH. 
  8. Promote the establishment of medical homes for PEH. 

 

Principle 3: The OMA acknowledges that patterns of disease in the homeless or houseless community differ from those in the housed community. Specialized training and educational opportunities should be available for all learners and clinicians.  

Recommendations:

  1. Endorse the development of healthcare training curricula - focused on the pillars of trauma-informed care, harm reduction, and value-based care - within professional schools, graduate medical education programs, and continuing medical education. In addition to these pillars, curricula should address disease patterns, treatment responses, and barriers to care specific to PEH. 
  2. Encourage student involvement in programs that promote direct engagement and relationship-building with PEH.  
  3. Advocate for the funding of research in the care of PEH.  
  4. Recognize that improving the practice of medicine for PEH requires structured ongoing input from patients and communities. Advocate for the creation of patient advisory boards, lived-experience consultants, and community feedback sessions within healthcare institutions and medical education programs. 

 

Principle 4: The OMA acknowledges that all patients have a right to self-determination in medical or health-related decision-making, and that while patients may not always make the best choices for their health, their choices are their own. Providing care for PEH requires a harm reduction lens.  

Recommendations:

  1. Recommend that healthcare organizations ensure that providers have access to training and continuing education in harm reduction principles to improve the quality of care provided to PEH.  
  2. Encourage the integration of harm reduction services—including needle exchange programs, supervised consumption sites, and medication-assisted treatment—into healthcare settings, ensuring they are accessible to PEH without stigma or barriers. 
  3. Acknowledge that working in this community can present unique challenges that are not typically encountered in standard practices. Peers and patients with lived experience as well as colleagues with expertise in working with PEH can better inform our practice 

 

Principle 5: The OMA recognizes that PEH with terminal or long-term debilitating medical conditions experience excessive suffering.  

Recommendations:

  1. Advocate for legislation and funding initiatives directed towards increasing the number of medical respite beds. 
  2. Advocate for funding for medical respite programs that extend beyond short-term stabilization, ensuring continuity of care for patients with complex, long-term medical needs. 
  3. Advocate for equitable access to palliative care and hospice for all Oregonians, regardless of housing status.  
  4. Ensure that healthcare facilities and services comply with ADA guidelines as PEH are especially impacted by disability.  

 

Principle 6: The OMA recognizes that providing quality care for PEH requires not only helping patients navigate social services and other barriers to health, but also confronting the profound emotional and psychological toll of witnessing exaggerated suffering. This work can be inherently stressful, leading to clinician burnout and frustration. 

Recommendations:

  1. Emphasize that all members of the healthcare team deserve support. Encourage the integration of trauma-informed mental health resources, peer support groups, and debriefing sessions into workplaces to help providers process grief, burnout, and moral distress associated with caring for PEH. 
  2. Promote education about healthcare for PEH to aid clinicians in understanding the complex behavioral issues that are inherent in this work, thereby improving preparedness for the job and minimizing burnout.  
  3. Recognize that healthcare organizations should take a leadership role in curating updated, dynamic guides to community resources and ensuring provider access to that information.  

 

See Appendix AA

Adopted by the Board of Trustees, May 2025

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