Marcel Slockers

94 Chapter 6 Homeless patients have impairments or diseases that require intensive support and treatment. About 30% of the homeless people in the Randstad (urban conglomeration of Western Holland) are intellectual disabled. 7 In Dordrecht and Venlo, this number among homeless people is 90%. The street wise behaviour of homeless people can be misleading for care workers. These workers might overestimate the homeless’ coping abilities when they fail to observe the mental retardation behind the ‘good story’. Substance abuse and maladjusted behaviour, are counterproductive factors when it comes to dealing adequately with the paperwork for the authorities. Working on a computer or applying for A DigiD (a kind of digital passport in The Netherlands) is for many a real problem. There are large differences in the way municipalities deal with people who have no address. After finding out someone is not registered, municipalities are entitled to investigate the matter. This can take a number of weeks. When a person has no valid ID, this process takes even longer. Even when the homeless patient does have a mailing address, the health insurer’s administrative procedures still take quite some time. In short, getting re-insured is a lengthy and intensive process during which one must meet certain requirements. Many of our homeless patients are not able to do this by themselves, so social care workers and case managers should play an important role in supporting these people. Homeless people are heavily dependent on a network of social care workers. Let us get back to our patient A. who returns to the street doctor with his prescription for insulin. How does the story continue? His case manager supports him in the process of re-insuring. The homeless patient has to prove that he is homeless and that he had spent all that time in this municipality. He must have a kind of ‘shelter card’ which he can get at a central coordination desk. The length of this process depends very much on the experience and authority of the particular social worker. A couple of weeks is not unusual in these situations. Workers of a special safety net within the GGD, have in some municipalities special arrangements on how to speed up the process of registration and insurance. Up until the moment of re-insurance, the insulin was paid through a financial agreement between an appointed pharmacist and a GGD. A street doctor provided the diabetic medical care in cooperation with a homeless shelter nurse.