Posts Tagged ‘homeless shelter’

Today I watched a woman and her boyfriend go “shopping” in our donations room….they have been wearing the same outfits for 2 weeks. They were so grateful for everything we had to offer. I was asked several times, “can we have this?” Every time I smiled and said of course..as they sorted through the items I heard them constantly say to one another, we don’t need that, leave some of those, this is amazing…

You see this couple had a rough past, burned the bridges with their loved ones, the only bridges not burned are through current drug users. They sought out help at a rehab. When they started dating they were kicked out of rehab…tossed to the streets. All of their belongings were kept at the rehab and they have nothing.  They didn’t want to speak badly about the rehab because they felt it had truly helped them. They are now staying in a winter shelter. How do we expect people to stay clean&sober? They fought the fight of withdrawal, found support and are put to the streets. I can’t imagine how hard it would be to stay clean facing the circumstances these people have to face. It’s very sad to me…we lack support in the areas that we need it most, for the people who need it and want it..

This couple, they told me not to worry, they found love and are going to support each other through this mess. I assisted them in getting clothes, hygiene products, nail polish…just so she could feel normal again…

And thank to the person who donated the Uggs…she was ecstatic, you would have thought she won the lottery as she screamed with joy. I wish you could have seen her face.

~Laura LaCroix, R.N.

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The vastness of need can seem endless.  When Brett and I started the DeSales Free Clinic, we had some experience under our collective belts to try to guide the creation of something that would be both meaningful and sustainable.  As it grew, so did our awareness about the larger problems facing the homeless population. Things like personal safety, humiliation, lack of affordable housing and lack of institutional loyalty.  It became easier to figure out reasonable treatment plans that actually had a chance of working because the context of their lives were so much clearer.

At some point, we started to become aware of the needs of other vulnerable and disenfranchised populations that were all around us. Human trafficking victims.  Domestic violence. Veterans. We learned that recently released inmates are 12.7x more likely to die within two weeks of release from prison than someone else living in their same state (Binswanger, NEJM,2007).  I still sometimes feel like a young PA student at Midwestern University all over again learning about the people that we share our world with but know very little about.  It is like standing in a dark room with the door closed. Then, someone turns on the hallway light and you see a small bit of light spread over onto your side of the carpet. Who turned on the light and who is on the other side of the door? Do you crack the door open and peak quickly? Do you fling the door open and boldly shout “Who goes there?”. Or do you retreat from the door and figure whoever turned on the light, didn’t really mean for you to see it anyway.  I think of the door as status quo.  It is always there and it is always accepted both socially and professionally. These populations often give us opportunities to engage them. They flick on the light in the hallway to see what happens to the door.  But all to often, we choose to retreat from the door and maintain the status quo.  The door never opens. Soon enough, the light turns back off and all goes back to the way it was.  But sometimes, someone flings the door wide open and invites the light in. Sometimes the door is opened by a patient. And sometimes the door is opened by a provider.  As it turns out, the light, in fact, is hope. And hope is just about the most powerful thing two people can share. A patient of Brett’s commented that he let the light in for her for the first time. Perhaps it was hope for her but little did she know that her willingness to let the light in  provides an understand that allows the light to be shared with others and the status quo to be challenged.

 

 

Snowpocolypse. Snowmaggedon. Holy -Snow-Batman! Whatever you call it, the snowfall over the last weekend was historic. But something else was happening in Allentown while we were all watching from our windows and marveling at this weather phenomenon.

On Saturday morning, with 9 inches of snow already on the ground, the Warming Station in Allentown sent it’s overnight guests to the streets because they are only operational at night. If it had not been for a local pastor, these people would have been left to try to find a public building to shelter in, a business that was trying to remain open that would allow for loitering or an abandoned building that perhaps no one would be looking for trespassers in. And what about the people who were not at the Warming Station the night before who may not have known about the good Pastor and his open doors?  How could a Warming Station staff street their guests who would need a plan to endure another 10-20 inches of snow before the Station opened again?

It really made me think about whose ‘problem’ the homeless people really are.  Why are there only a few who will take responsibility or, dare I say, ownership over  ‘their’ problems? Are we societally too stoic, compartmentalized and self-determined so that we believe that those who face a blizzard alone and homeless should have thought about that before they ‘made all their bad choices’? Are we worried about becoming too involved, caring too much, knowing too much only to find that there are too many one-way, dead end streets in our society? Do we fear the futility that comes with knowing without being able to act?

It would be easy to blame the operators of the Warming Station for streeting these people in the face of an impending Blizzard. These stations are opened on the heels of a public health concern.  Who wants to have citizens of their town freezing to death on their streets? But it is also a public service based on the principles of justice and beneficence. So how could people be left to fend for themselves in these harsh conditions? Dr. Jim O’Connell, founder of Boston Health Care for the Homeless Program, and a Harvard trained physician issued guidelines on temperature associated health risks to the homeless. The bottom line is that while water freezes at 32 degrees, human flesh is at risk for freezing at just 40 degrees. Often the greatest risk occurs when the ambient temperature is warm during the day and then drops drastically at night. From a business standpoint, a warming station could say they don’t have funds to pay for staff to be there during the day. They don’t have a food source there. Maybe they don’t have permission to keep the building owned by the Park and Rec Department open during the day. There are a hundred other reasons that they could come up with and some might be true. But the truth of it is, it doesn’t matter. These are people and they needed shelter. Could there have been a solution? A work-around?

The gravity of this current snow situation for the homeless is likely not to be understood for some time. But with each challenge must come insight and solutions to minimize risk the next time around. First, is the issue of the Code Blue designation. The Code Blue designation is issued by Lehigh County Emergency Management when temperatures dip below 32 degrees. The Code Blue status is supposed to be posted on the Lehigh County Emergency Management website but currently does not indicate a Code Blue listing. Today is a high of 26 and a low of 9, certainly we meet criteria. ‘Code Blue’  isn’t a searchable term on their website and it is difficult to find any information about what this designation really means. Anecdotally, I can tell you that local shelters loosen their admission criteria and put people any where they can as a temporary measure. The most current listing of Code Blue places available on the internet is from 2014 and basically contains a list of local shelters. Shouldn’t this designation allow for other buildings owned by the City to remain open as a public health measure? And why is the temperature cut off 32 degrees when data supports danger starting at a temperature of 40 degrees?

Second, those who are in the business of providing shelter as a public service should be held accountable for their actions. Many of these shelters and warming stations receive monetary support from citizens, government, grants etc. who expect that they are providing the service of warming and shelter.  You are accountable to your stakeholders. Is the city of Allentown responsible for sheltering these people or are they relieved of their responsibility because they funded another entity to provide this public service?  Take the example of our local hospitals. Healthcare workers slept in the hospital and shoveled on-ramps on 78 in order to get to work because the hospitals take their responsibility of being prepared for patients despite weather or any other natural disaster. The hospitals require it and the healthcare workers abide by it because of their moral responsibilities to their patients. Another example is the accountability of disaster preparedness where organizations accept risk for the greater good. Successful organizations balance between risk and preparedness with the ethical principles of justice and nonmalifecence. These preparedness documents should be well thought out and easily implemented. Just as in disaster preparedness, when running a winter shelter, one must be prepared for winter weather.
Finally, there is the humanistic aspect. In times of trial when human lives and dignity are on the line it is ALL of our responsibility to care for those in need.  If you’ve accepted the public commission to care for the most vulnerable, you can’t abandon that post in the worst of times. At the same time, if you haven’t accepted that post in an official matter you aren’t absolved of your moral responsibility. This weekend in Allentown that is exactly what happened. Although not bound by grants or funding, Zion Church opened their doors to those most in need of sheltering from danger, just as they did in 1777 when they “housed” the Liberty Bell, keeping it safe from the British during the Revolutionary War (www.libertybellchurch.org).  Let it be a lessoned learned; that true responsibility comes from within.

Caterpillars are not particularly ferocious creatures. Slow and steady and according to my children, very hungry. I am not even sure that they make any noise at all. Or, come to think of it, have any teeth. They do their thing in their unassuming way and eventually make it to butterfly utopia. Silently and without bells or whistles, they make the world a more beautiful place. I have often marveled at the way passion can turn an otherwise quiet and unassuming human into a bull in a china closet. I am certain you have witnessed this phenomenon and it can happen to any of us. Once, while sitting in an ethics lecture some years back, a girl who I had never heard even speak suddenly found her voice and schooled the room about the seemingly double standard in the world regarding when life begins. Looking around, her point had not only been made, but her peers were blown away by the passion that was residing within her.

Advocates for many causes are much like the girl I just described. I remember a neighbor I had who loved animals. She always had a foster animal that she was rehabilitating for adoption. She would spend hours nursing the animal back to health. Once, I got up to go to the bathroom late at night only to glance out the window and see her sitting beneath a porch light picking fleas out of a sad lump of fur. I didn’t understand it then, but I do now. For some people, it is animals or organic food. The environment or breast cancer or autism or homelessness. World hunger, toxic waste or children in Africa. The cause is different but the root is the same. All causes need passion like this. It is what inspires other people to give two rats patooties about something they otherwise couldn’t care less about. I often think that I relate more to people who are passionate about SOMETHING (even if I fall into the rats patootie category about the cause) than those who are indifferent about EVERYTHING.

I am often asked how we do it all. I can see the look in people’s eyes as they ask the question. It is a third happy, a third bewildered and a third concerned. They know we have many clinics and homeless responsibilities. I myself work one full time job and two per diem jobs in addition to my obligations to the homeless. We have three children and other community responsibilities. I know why they are worried and why I am not. The answer is simple. I am compelled. I know that it is not I who is in charge of this master plan. Tenui nec dimmitam- latin for “I have taken hold and I will never let go.” This phrase reminds me to breathe easy, let it go (not the Frozen kind) and have courage.

Caterpillar roar.

I’ve never given a eulogy before. While preparing for his, I realized I really didn’t know much about him, but felt I understood him. The two words that best described him were courage and character. Not usually the first two words that come to mind when picturing a man who made his home in a drainage pipe for almost 5 years. He never left because he said, “It was a good spot.” In fact, none of the homeless providers knew who he was until the day he came into our hospital complaining of abdominal pain. At the time, it seemed like his life was finally turning around. He had a job. After months of trying, he got a job which required an almost 10 mile walk each way daily. He was saving his money and had an apartment picked out closer to his work so he could, “walk to it,” which always made be chuckle when he said it.

“Courage” describes him so well because the day I met him (in the hospital) was the day I told him he had a terminal illness and only a few months to live. He smiled his crooked smile that I would see so much over the next few months, shrugged his shoulders, and said, “Well, I guess that’s the way it goes….. What do I do now?” At first I wasn’t sure he understood what I just said so I repeated it and his reaction made me understand that he did understand, and simply had a degree of bravely rarely seen. He asked me what they would do with him after he dies. I honestly wasn’t sure so I asked what he would like us to do. He said all he wanted was a box with a cross on it but nothing else. He also told me he was Catholic but hasn’t attended church in about 15 years and wanted to know if it was ok to see a priest.

We told some of the local landlords about his situation and helped with getting an apartment for $250 a month so he wouldn’t have to spend his last days in the drainage pipe, no matter how good of a spot it was. He saw me at least weekly in the soup kitchen and was visited by our hospice nurse much more often in his new apartment. We also arranged for him to go into our inpatient hospice unit whenever he wanted, even if it meant his stay could last months, which isn’t the normal procedure for an inpatient hospice unit. He said he would stay out as long as he could so the people who were sicker than him could have the bed. By making that decision, it meant he would continue to struggle finding food daily, walking miles to different soup kitchens even as he grew weaker. I soon learned that his weekly walk to see me at the soup kitchen was the barometer he used to tell him when it was time to enter the hospice unit.

As time went on he grew so weak he could no longer make the walk to see me, was vomiting all food and drink, and was even having trouble getting around his apartment. Also, the heat broke in his apartment—in January—which he said didn’t bother him because he still had a bed and 4 walls, which is more than he had the last 5 year. With his nurses help, we convinced him to go to the hospice unit and he agreed. He wouldn’t go until he cleaned his apartment, packed up all his belongings, and took it to the shelter to give them to someone who needed them. We tried to talk him out of the strenuous task of cleaning when he was barely able to walk but he wouldn’t hear of it. The landlord was so nice to rent to him at such a low price he couldn’t leave the apartment dirty, he said. When I think of his strong character, I consider that for a man who had so little in life, and was now so close to death, his biggest concerns was for the sicker people in the hospital than he, the other homeless who were more in need of clothes than he, and not violating the trust of his landlord who first showed trust in him.

While delivering my eulogy I looked out in the full seats in the funeral home and was struck by how many people he brought together. All of his caretakers and an old acquaintance from high school came to say goodbye with a priest presiding in front of his beautiful box with a cross adorning the top. In the end, he got all he wanted, and we received a lesson of a lifetime.

-BF

Yesterday afternoon, a few of my co-workers and I were walking to a picnic held on the DeSales University campus. We were admiring the beautiful weather and the beautiful surroundings. Despite my love for the urban and rural homeless population, I have to admit it is a quiet retreat to spend time on this beautiful campus of rolling hills and beautiful fields.We noted a tree that was already changing it’s leaves. This launched a whole discussion about how everything is in a hurry- A.C. Moore already has Christmas decorations for sale and emails are jamming my inbox with taglines reminding me how many Fridays are left until Christmas. I, for one, have never really enjoyed winter. If the weather could stop at late October and blend right into April, I would be happy. The prediction for our area this year is another unbearably cold winter with higher than average snowfall. Putting my own last winter-related, generator-finding-polar-vortex-enduring PTSD aside, I think to the other work in my life.

It was a Sunday at the end of February 2014.   Brett’s cell phone rang and it was Jackie, a parish nurse who works with Brett at the Soup Kitchen Clinic. She was calling because she had a patient with her who was desperate to find someone named Corinne who normally takes care of him. She wanted to know if Brett knew who this Corinne person was. Much to her surprise, he passed the phone to his right and she got her answer. It seemed that Kevin* had been asked to leave the homeless shelter he was previously staying in. He had violated one of their rules and as Kevin said, “That was that.” He was out of medications but more importantly, he was out of shelter . The only other place to find shelter was over full and Kevin had been denied entrance the prior two nights. The temperatures were drastically low and he was scared and cold. He had only been able to take the belongings that he had near his bed. All of his items in storage, he told me, were discarded. Imagine the attachment you would have to your belongings if you could count all of them on your own two hands. More concerning, Kevin suffered from incontinence. Not having a reliable place to use the restroom and clean clothes to change into worsened the situation.

Kevin has been my patient for the last two years. He comes to the Clinic religiously every Tuesday for a blood pressure check. The blood pressure check almost always reveals more information about his week, his life and his other medication conditions. Despite his chronic incontinence, he always smelled like cologne. Kevin was compliant, he was never late for an appointment I had set up for him and he never ran out of his medications. He is talkative, polite and wonderful with the students. He had often told me he liked helping the students get their education. The students felt responsible for Kevin, but Kevin also felt responsible for the students.

Kevin and I agreed to meet on Tuesday. I went to my PA students and explained Kevin’s situation. Most of the students knew him from the Free Clinic and were deeply saddened to think of him sleeping on the street. I could see it in their faces- homelessness just got real.

Being that Kevin is a very tall man, finding clothes for him would be difficult. But the students rallied and came up with clothes, toiletries, snacks and other things they thought he would need. I arrived to meet him a few minutes early. In a strange change in weather, the polar vortex had given way to an unseasonably warm that day with a high of 62. I had not even worn a coat as I walked from my car to the building and I passed a few overzealous locals in shorts and tank tops. A few minutes later, I looked out the double glass doors to see a man dressed like the Abominable Snowman. He was struggling with the heavy doors and as I walked closed to help him, I realized it was Kevin.

Everything he owned was literally layered on his body or crammed into a messenger bag that was ripped down one side. Over the course of 10 minutes, he removed from his body 4 winter hats/hoods, two pairs of gloves (both ripped), a puffy winter coat, a leather jacket, a windbreaker, two sweatshirts, a button up collared dress shirt and a long sleeved t-shirt. He had on three pairs of pants, all of which were soaked with urine. What bothered me more than his layers, was his facial expression. Minimal eye contact, soft voice. No smile, no light hearted upbeat Kevin. The Kevin was lost, buried in the pile of clothes sitting beside him. A sadness filled his eyes. He told me he was so embarrassed for me to see him this way, embarrassed to walk the streets literally wearing everything he owned. He didn’t know what to do, where to go. He was desperate. Then his phone rang and it was his mother. She wanted to talk to me. I could hear it in her voice. She begged. She pleaded. “Find him somewhere to sleep tonight! Please! Why isn’t there anywhere else for him to go? Where are all the other people who are homeless?” Her questions were valid. Her frantic tone of voice was justified. Her disbelief that we have nowhere to put our homeless at night. I apologized, I justified, I rationalized, I validated. But in the end, I had no answers.

Then it was my turn to beg and plead. Could he come home to her? Were there resources for homeless in her town? Could she think of a family member, a friend, anyone who would take him in? All the answers were no. And while she wouldn’t elaborate as to why, I could sense that her answer was non-negotiable. There was no answer for Kevin that night. He had nowhere to stay and nowhere to go. It was gut wrenching. As a health care provider, I felt horrible. As a mom, I cannot imagine laying in my bed at night wondering if my son was sleeping outside in the cold. As a friend, I felt helpless. I could work no miracles that night. He slept outside behind a YMCA and waited for another day.

Eventually, we were able to convince the shelter that had asked him to leave to reconsider their decision. Kevin was permitted to return to the shelter and has been diligently working on filling out government paperwork, attending doctor’s appointments and applying for housing. Last week, he proudly reported that he had work with a local resource to update his resume and had interviewed for three jobs. Progress was being made and I am so proud of his recovery trajectory. As summer fades to fall, I know that Old Man Winter is waiting just around the corner. He lurks and just when you have almost forgotten the bone chilling cold that makes you want to pack up and move South for good, he snaps you back into His frosty world reminding me that “Walking In A Winter Wonderland” could have only been written by a person who was housed.