The American Indian Community Development Corporation (AICDC) in Minneapolis recently received a letter from Hennepin County announcing that it planned to cut all funding for the Kola Program, which provides medical services to homeless people with a focus on Native people struggling with alcoholism. Kola, which means “friend” in Lakota, serves 30-60 clients a day and over the years has helped thousands of homeless men and women.
The letter stated that Hennepin County would zero out its funds for Kola in three months, due to the county’s overall budget deficit. It invited AICDC to request a hearing if the agency wanted to appeal.
Michael Goze (Ho-Chunk), President of AICDC, said he participated in hearings on November 3 and 17 to protest the $164,000 cut. That amount represents 80% of the Kola Program budget.
“I understand the process and the deficit piece,” said Goze. “We’re all for saving money, but that’s not what this cut would do. In addition, this population is vulnerable and services are often a challenge.”
Goze argues the cut won’t save money for Hennepin County, because Kola clients often have medical conditions that are ignored or do not receive treatment in other clinics due to inebriation. When these conditions are allowed to worsen, clients use county emergency rooms, which are more expensive.
Dr. Ken McMillan, the physician for Kola, agrees. “I definitely believe Kola saves the county money,” Dr. McMillan said. “From a clinical point of view, we see patients when they are questioning the severity of an injury or deciding if they need attention. We then provide the care that prevents a situation from advancing to the ER.”
Dr. McMillan described several typical scenarios, such as a client who asks for a bus token to get to the ER, but Kola is able to offer treatment instead. Or a client who requests medication for a condition which Dr. McMillan then diagnoses as a more serious problem, intervening before the condition deteriorates.
In some cases, Kola treats an illness or injury and makes it manageable until a client can get to a specialist rather than rushing to the ER.
“We presented our contention at the hearings in front of the county board,” Goze said. “We pointed out that these cuts will affect a population that has its own particular concerns and medical conditions. As a result, Kola saves the county money.”
Goze is also worried about the future health and treatment of Kola clients, many of whom face aging with chronic disease and chemical dependency issues.
County Commissioner Gail Dorfman, a past supporter of Kola, has introduced a budget amendment that would restore full funding. “Kola is an important program, but I’m not sure I’ll get my amendment through,” Dorfman said. “It is a tight budget year, and a lot of agencies are facing cuts. I’m not sure I have the support.”
If the board doesn’t approve full funding, Dorfman says she will ask again for a lesser amount. The board plans to vote December 4.
Kola is an efficient and streamlined program. Dr. McMillan works with a medical assistant and administrative assistant to provide services. “If Hennepin County doesn’t reinstate the funds,” Dr. McMillan said, “I don’t see how we could go on doing what we do. I’d volunteer a few hours a week, but Kola would have to cut to bare services. I would have to look for other work.”
Dr. McMillan notes that 25-33% of the clients are uninsured, so Kola cannot bill for those services. When Kola does bill, the income covers some of the medication, a program van, and malpractice insurance but not the bulk of operating expenses. Typical Kola clients are men in their thirties struggling with depression, mental illness, and chemical addictions. They are often talented and self-sufficient, distrustful of other shelters and clinics, and show extreme loyalty to each other.
The Kola staff is honest with clients about the potential cut in January. Some clients offer to volunteer more time at the desk, which has helped during small budget shortfalls in the past. Some ask why the tribes do not contribute more. Dr. McMillan noted that three or four tribes have donated this year, but Kola would need a major infusion to replace this cut.
Dr. McMillan said he would be upset to lose the program, because the clients have built it themselves, with their trust, work, cooperation, and referrals. Kola’s goal has always been to help clients help themselves, and in anonymous client surveys, Kola receives an 80-90% approval rating, which is high from a population wary of human services.
He is also proud of the successes, not just clients avoiding death but achieving stability in housing and sobriety. Dr. McMillan recently gave a presentation about Kola at a Homeless and Trauma Medicine Conference in Sioux Falls, SD. He ran into a former client who is nine months sober in his own apartment. The man struggled for three years with homelessness and alcoholism.
“He was happy to see me, because Kola had seen him when he was hopeless,” Dr. McMillan said. “We connected him with a single person, a support coach, who helped him.”
Kola was founded in 1999 to provide culturally-specific supportive services to chronically-inebriated, homeless American Indians. Hennepin County helped to launch Kola, and Dr. McMillan says he is grateful for that assistance.
“I would very much appreciate continued support until homelessness is not a problem anymore,” he said.
Kola continues to offer healthcare outreach, health screening, and referral services to many homeless American Indians who are chronic late-stage inebriates. Dr. McMillan and the medical assistant do everything from patching wounds, to ordering prescription refills, to treating sore feet, to screening for hypertension and diabetes.
In addition to these hands-on services, Kola staff offer education regarding HIV, hepatitis C, and tuberculosis. They help clients meet basic needs such as showers, blankets, and clothing. Kola also encourages sober activities. During its open daytime hours, it has telephones, computers, and information technologies for clients to use.
The goals of Kola include reducing the number of deaths on the street due to chronic alcoholism or homelessness, improving the general health of a high-risk vulnerable population, decreasing inappropriate use of ERs and detox centers, encouraging periods of sobriety, restoring dignity through goal setting, and providing a holistic approach to life change (physical, social, emotional, spiritual).
Kola is open 7:00 a.m.-1:30 p.m., Monday-Friday. For more information, see www.aicdc-mn.org.