J.T. Barker sometimes lives in the woods near Veterans Park in Dundalk and at other times sleeps in the shadows of an industrial park.
On a recent hot and muggy day, the 43-year-old homeless man found a little relief in the air conditioning at the Health Care for the Homeless Baltimore County medical clinic where he goes about once a month for free treatment. This day he needed a refill for his asthma medication.
Located on the campus of MedStar Franklin Square Medical Center in Rosedale, the tiny clinic provides primary care and referrals for specialty services to treat mental illness and substance abuse among the homeless. To better meet the needs of the county's homeless, it's about to be relocated nearby and tripled in size.
With constant exposure to the elements and limited or no access to nutritious foods and insurance, the homeless face difficulty staying healthy. They have high incidences of heart problems, diabetes and other chronic conditions that can be hard to manage without stable housing and medical care.
Since 2008, the Health Care for the Homeless clinic has served this population when others wouldn't. Many of the patients are uninsured or have limited insurance through a state program for adults who fall under a certain income level.
The clinic saw 2,264 patient visits last year, but medical director Tobie-Lynn Smith said it was not reaching the estimated 7,000 to 8,000 homeless who live in Baltimore County.
"A lot of that is because of space," Smith said. "We obviously are not getting everybody."
The clinic now operates from 600 square feet of space. There are two examining rooms, one of which has a curtain rather than a door to separate it from the rest of the office. A note taped to the medicine cabinet and directed at staff reads: "This is a very small space. Please clean up after yourself and put away items that you use."
The clinic will triple in size under a $14 million plan to relocate it and the Eastern Family Resource Center, which provides housing, meals, job assistance and other services to homeless families, to a new 60,000-square-foot building on the campus of MedStar Franklin Square. Many of the center's clients also get care from the Health Care for the Homeless clinic.
To fund the new building, the state is giving $4.875 million, Baltimore County $4 million and MedStar Health $5 million. MedStar Health has been a longtime partner with the clinic, which the hospital staffs.
MedStar Health will be able to continue expanding the hospital once the homeless resource center and health clinic are moved. The hospital completed work in 2010 on a $175 million patient care tower adjacent to where the clinic is located now.
The timetable for the move and expansion still is being worked out, officials said. Right now, they are soliciting architects.
Smith and others said that the expanded clinic is needed because everyone deserves health care, whether or not they have a place to live. Treating the homeless regularly also cuts down on emergency room visits, which are more costly than regular care.
"We are committed to having care on the front end, which is much cheaper than care on the back end and not the best use of medical resources," said Samuel E. Moskowitz, CEO of MedStar Franklin Square.
Many of its patients first visit the clinic because of a health problem that needs immediate treatment, Smith said.
"Once we capture them, we try to get them to come back for regular care," she said.
The current clinic's cramped quarters don't bother Barker, who works at the port of Baltimore but doesn't have enough money to rent a place to live. He said he is grateful for the health care he receives there.
"They care about the well-being of people like me, and they don't look at us like monsters," Barker said.