There are also management issues related to how the Milwaukee agency is administered according to the policies and procedures promulgated by the national organization. For example, in order to provide more one-on-one contact with clinicians who have expertise in homelessness, the HCH Network also identifies clinicians from each of the five Clusters to work with the health center team in Milwaukee. This Network representative serves on the national organization's Cluster's Steering Committee; in this capacity, the primary responsibility of the Network representative is to share specific expertise and knowledge about providing primary health care to homeless people. This ongoing initiative is intended to help ensure that the unique needs of homeless people are addressed by the HCH Collaborative (Health Disparities Collaboratives, 2005).
There are also management issues related to the allocation of resources to target specific population groups in the Milwaukee PMSA. For example, Baumohl (1996) reports that children who are forced to live in shelters may experience poor health as a result of poor nutrition, communicable diseases that spread in congregate living environments, inadequate sanitary facilities, and to noise and light that disrupt sleep. "Shelters in many cities require families to leave during the day," he says, "making it difficult for young children to nap or for sick children to recuperate. Homeless children who live in cars, abandoned buildings, or in the open may suffer from exposure to the elements and are even less likely than shelter children to have adequate nutrition, sanitary facilities, and places to sleep" (p. 119). In many areas of the country, health care for such homeless children is provided by special programs operated by Health Care for the Homeless; however, in other parts of the country, access to timely care and a consistent health care provider may be difficult or impossible (Baumohl, 1996).
Money. Because resources are by definition scarce, it is critical that HCH remain a careful manager of the funds that come into its care. In this regard, the following tables provide financial statement data from 2004 for HCH. As can be seen in Table 2 below, at first glance, it would seem that HCH enjoyed a solid financial basis at the end of last year:
Table 2. Revenue and net worth for Health Care for the Homeless, Milwaukee, WI, 2004.
Revenue and Net Worth
Amount
Contributions
Other revenue
Total revenue
Beginning year net worth
Net worth changes
Year end net worth
Source: Wisconsin Department of Regulation & Licensing, 2005.
As can be seen from the "bottom-line" in Table 3, though, HCH incurred a $292,362 deficit in 2004.
Table 3. Health Care for the Homeless, Milwaukee, WI, financial information for fiscal year 2004.
Expenses
Amount
Percentage of total expenses
Other percentages
Program services
102.76% of total revenue
Management and general
Fund raising
0.00% of contributions
Payment to affiliates
Total expenses
Excess deficit
4.50% of revenue
Source: Wisconsin Department of Regulation & Licensing, 2005.
Constructive criticism and/or recommendations for future strategies and directions.
Concern for the homeless and their need for quality health care is nothing new; however, more attention is still needed. St. Martin (1996) advises that, "The new focus on quality does indeed represent a paradigm shift in the most fundamental sense from a concentration on assessment and monitoring... And from a provider and process orientation, to a customer and outcome orientation" (p. 84).
1. Establish an Internet present using a free hosting service. Even though a so-called "digital divide" exists between the information "haves" and the "have-nots," the U.S. has more than 15,700 public libraries that are helping to close this "digital gap" by providing free Internet access to numerous rural and impoverished areas where citizens frequently lack any alternative methods of online access (Semitsu, 2000). Therefore, projecting an Internet presence to help advertise the availability...
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