Denise Rosa was in a line of 30 unhoused people outside of a mobile clinic parked at the Christian Service Center for Central Florida, west of Downtown Orlando. It was her first time there, but she was grateful to receive help for her multiple ailments.
"I got stuff for bronchitis. And one for my ankle. 81 milligrams, like aspirin for blood clots. It's cold and my body hurts as well," said Rosa, 52 years old from Orlando.
The area around the Christian Service Center is usually busy with unhoused people looking for food and help, but on every other Sunday people arrive in crowds looking for medical help. A retro-fitted ambulance arrives with clinical supplies, and a group of volunteers, and part-time workers come ready to assist. Ever since the mobile clinic began rolling in 2017, the staff of the American Muslim Community Clinic has been seeing more homeless people request primary care and wound care.
Numbers grew even faster as a result of the 2020 COVID-19 pandemic, and to make matters more difficult, it's facing increasing costs of supplies while seeing a decrease in monetary donations.
“We've had like 200% growth (homelessness patients,) right? Yeah, I'm not joking. I wish I was. My finances have not grown to 200%,” said Atiff Fareed
The mobile clinic began bringing services to homeless groups after seeing a growing number of homeless people in Orlando with health care needs and a lack of transport. Fareed said the mobile clinic continues to see more and more people but finances are not keeping up. Currently, it’s operating at a deficit and is working with 25% less funds than it did last year.
“It costs us more money to operate the mobile clinic. But it's such a necessary (service), and no one else is doing it,” Fareed said.
On some days, over 50 patients are waiting for the AMCC ambulance clinic to arrive.
After receiving her medication, Rosa placed it along with a bit of food in a shopping cart that contains all of her belongings. She had been sleeping outside of the Orlando City Exploria Stadium for nine days. Rosa is an Orlando native and has been homeless for most of her life, but it was her first time at the clinic.
"I never thought I would need it," she said. "I can't go see my doctor because I'm currently not on (medic disability insurance.) Once I get back on disability, everything will fall back in place."
Most mobile clinic patients don't have insurance, Fareed said, and receive the clinic's services at no charge.
Nine days before arriving at the clinic, Rosa was in Missouri looking for work. But she said it got too cold so she headed back south. That’s something Muhammad Hamid, a physician assistant with the Mobile Clinic has been hearing a lot of.
"A lot of them say that the warm weather, whenever it gets cooler, November, December, they cannot stay in the northern states are the colder states," Hamid said.
While the weather may contribute to a seasonal increase, Central Florida homelessness is up by 75% since the start of the COVID-19 pandemic largely due to evictions according to the Homeless Service Network. Between 2021 and 2022, the number of those living without shelter grew by 38%. Additionally, in the early part of 2023, HSN counted over 2,200 people living on the streets in Orange, Seminole, and Osceola counties — a 5% increase over last year. This number does not quantify how many people were living in shelters.
Greater costs
Dealing with more unhoused patients means more wound care, but due to an increase in supply cost the mobile clinic doesn’t always have what it needs. There are times, Hamid said, he has to “MacGyver” first aid supplies, like the time a patient needed lidocaine and stitches, and he had neither.
"I had to wash (the wound) down with betadine. It's like a disinfectant, and I cleaned it up. I had to put a bandaid on it, and then I had to put an ace bandage around the bandage to keep it closed, but I didn't have stitches. I didn't have the scissors," Hamid said.
The clinic is treating more homeless, and it also spends more on medical supplies — which increased across the country by 19% between 2019 and 2022. Fareed said the cost of supplies is outpacing inflation.
"The inflation rate is less than 10%. But some of the costs are going up 150 to 200%," Fareed said.
In October, the Biden Administration opened Medicaid services up to street medicine providers — meaning teams could charge their expenses to the Centers for Medicare & Medicaid Services. However, the Medicaid expansion is not a solution for the AMCC mobile clinic's financial challenges due to its sovereign immunity — which is a protection by the state that prevents malpractice lawsuits.
According to a Florida statute, medical organizations that receive sovereign immunity can lose it if they accept public or private funding from a third-party source. In short, if the clinic accepted federal dollars, it would lose its legal protection.
In light of a year of smaller donor contributions, the clinic also faces the challenge of insurance. Fareed said just two years ago, he was paying $1000 a month, and now he’s up to $4,400. To help overcome the costs, Fareed is seeking grants and strongly encouraging donors to make larger contributions.
He’s confident they’ll come through.
"You don't get what you deserve. You get what you negotiate, and you get what you work hard for. So my financial issues at the clinic, I am going to negotiate and I'm going to work hard to get more grants," he said.
Recently, Adventhealth Central Florida agreed to sponsor the clinic twice a month throughout 2024, according to an Adventhealth spokesperson. The sponsorship will cover diagnosis and treatment of illness; disease screening and prevention as well as the management of chronic illnesses such as diabetes and high blood pressure. Any needs for dental care, will be referred to the AMCC's brick-and-mortar Longwood location. Volunteers with SALT Inc. — another philanthropic origination that helps the homeless at the Christian Service Center — drive those without transport.
The Homeless Service Network won’t release its overall 2023 Central Florida Homelessness numbers until later next year, but members of the AMCC expect the growth rate to remain the same or increase.
