by Fran Kritz, California Health Report
January 11, 2019
For people living on the streets, phones are a lifeline. Increasingly, applications for services such as shelter spaces and benefits must be done online or through email. More and more doctors’ office use online platforms for appointment scheduling and reminders, test results and prescription reminders.
Having a disposable phone, or no cell phone at all, makes it difficult for people living on the streets to maintain relationships with the case workers and health care providers critical to remaining healthy and becoming housed, according to a new study.
Cell phone complications “just make an already very difficult life that much harder,” said Margot Kushel, a professor of medicine at UCSF. Kushel is senior author of a study published last month in the journal JMIR mHealth and uHealth.
Most of the study participants – homeless men and women age fifty and older* and living in Oakland – had a cell phone. Yet of the 75 percent who had a phone, two thirds of those had no internet access. Fewer than forty percent of those in the study, part of a larger one called HOPE HOME that is funded by the National Institutes of Health, had accessed the internet in the previous month.
Phones have become more affordable, thanks to inexpensive disposables available at convenience and chain stores. But disposables create their own problems. They have a finite number of minutes and are useless when those run out, requiring a new phone and number.
So while more than 70 percent of the men were enrolled in a health clinic, and more than half had a dedicated primary care provider, many still used emergency rooms for at least some health care. One reason is that when cell phones run out of minutes, homeless individuals often lose their contact information, including information for health providers, and those providers did not have new contact information for them.
“If I call someone back to give them test results or schedule a follow-up appointment, it’s such a common problem for a phone number to not still be their number,” said Kushel.
Free Phones Available, but Address Required
Maria Haverstock, 65, was homeless for more than five years, living on the streets in the Bay Area. Now she has permanent housing in a hotel in Oakland. While homeless, she changed disposable phones often. Friends, family and health providers had a hard time reaching her. “It was very frustrating,” Haverstock said, “but less frustrating than not having a phone.”
Haverstock has a smartphone now, through a program called Lifeline, run in California by the California Public Utilities Commission. The program provides free or discounted phones and internet service for low-income households.
Applicants must have a street address in order to get Lifeline service, however, putting the phones out of reach for many who are homeless. (Lifeline California did not respond to requests for an interview).
With her current Lifeline smartphone, Haverstock can email her doctors to stay in touch and schedule and confirm appointments. “When I was homeless,” she said, “I didn’t have a regular doctor because I couldn’t get to one, and I often didn’t have a way to contact them.”
Streets Plus Phones Equals Breakage, Theft and Dead Batteries
Getting a phone doesn’t necessarily solve these problems. “Being on the street means phones are often stolen, lost or broken and Lifeline has a limit on how many times they will replace the phone,” said Brenda Goldstein, Psychosocial Services Director at Lifelong Medical Care, which provides health care to the underserved in Berkeley.
Sparrow Mobile, a social impact mobile phone company based in San Francisco, works with social service agencies to identify at-risk people in need of phones. Through grants, contracts and income from paying customers, the company provides free devices and data plans to people in need. To date, they have given phones to more than 500 homeless people in the Bay Area.
Amy Tucker, the company’s co-founder, said they once took two hours to track down a new homeless client, guided only by guesses from social workers about his location. That night, his brand-new smart phone was stolen from around his neck. Sparrow Mobile replaced it with a basic phone, less likely to be stolen.
In cases where Sparrow replaces phones for homeless clients, the telephone number remains the same. Lifeline changes the number each time a phone is replaced.
Without easy access to electrical outlets, keeping phones charged is also a challenge.
“Many businesses turn off their outside plugs to prevent homeless people from charging,” said Bob Erlenbusch, executive director of the Sacramento Regional Coalition to End Homelessness.
Homeless Youth More Likely to Have Phones, But Also Struggle With Cost, Theft and Breakage
A survey that included questions on cell phone use by homeless teens and young adults was conducted in 2017 by Realyst, a research collaborative on youth and homelessness. Survey responses came from homeless youth under age 26 in seven cities including San Jose and Los Angeles and found that 75 to 80 percent had a smartphone and another 17 percent had a basic phone, according to Robin Petering, a REALYST researcher and youth homelessness advocate in L.A.
Eric Rice, an associate professor of social work at USC, who has published studies on homeless young adults and cell phones says that’s no surprise, even if they have to scrounge to afford monthly payments.“They are adolescent first, and homeless second and have you ever seen a young adult not surgically attached to their phone?”
Petering says young people have the advantage of being able to make an inexpensive smart phone work for them without a data plan—by standing outside businesses to use wi-fi and making calls over Facebook Messenger, WattsApp and Google Voice-- skills many older homeless adults just don’t have.
Solving Housing Also Solves the Cell Phone Problem
The real solution to cell phone access and longevity, as well as the host of other problems faced by people who are homeless, is permanent housing, said Kushel.
In the meantime, said Kushel, making some changes to the Lifeline phone program, such as smart phone training, ending the requirement for a street address and allowing owners to keep the same number even if they lose the phone, would make life much easier for people who are homeless. “The phone is not the solution to the homeless crisis,” Kushel said. “But we should be doing everything possible to make these people’s lives easier and alleviate the unnecessary challenges they face.”
*This story has been updated and corrected. The original version of this story stated that the participants were 350 African American men 50 and older.
MAIN IMAGE SOURCE: Thomas Hawk/Flickr/CC BY-NC 2.0.