Homeless Healthcare

A mother's first person narrative on surviving homelessness.

It’s 2001, September. The mom lives in a small but important apartment in Massachusetts with her husband and kids. It is tiny and rundown, but it is a home. ‘I was doing daycare out of there but after 9-11, everything changed’

The mom’s husband loses his business and soon after the couple is forced out of that tiny home. Their landlord has to repair their entire apartment to meet Board of Health rules, ‘so they raise the rent to what they know we can’t afford.’ The mom and dad put everything they own into storage and move into their mother’s house. Their path to recovery begins, but it gets worse before it gets better.

***

Amy Grassette’s path to recovery and her efforts to give back by improving access to healthcare for homeless is astonishing. ‘We signed up for section 8 and were told we would get it quickly. They encouraged us to call every month,” Amy says. “We stayed with my mother for several months but it got very difficult to be in that situation. The welfare department told us there were no shelters and they wanted to split up our family….but we couldn’t do it’

The Welfare Department ended up putting Amy and her family in a hotel for nearly 4 months. ‘I found myself swallowing my pride. When you’re living in a hotel you’re eating a lot of frozen and deli items. Food pantries mostly had canned goods so I would go out once a week in the area and explain to them what our family was going through. Most of the time they helped us. Sometimes we just needed bread and milk. I went to the local grocery store and talked to the manager and he gave me money out of his pocket. People stepped in and helped us’

The family eventually moved out of the hotel and into a homeless shelter. It was unique that they were an in-tact family. Most others were split up. They had their own room. ‘I was grateful that we were able to stay together….I saw that many people were very beaten down by the system. I remember a woman coming in with a little boy and a trash bag of things and I gave her a hug and said it’ll be okay.’

The moms are still friends today.

***

In the shelter, Amy starts to get involved. She is not a public speaker but slowly starts to find her voice on things she doesn’t think are okay, things that aren’t fair. She gets connected to the community health center at UMASS, which helps since her husband gets kidney stones that are not addressed quickly enough, so he has to go through 8 months of treatment. ‘I wondered how this would affect my kids in the long run,” Amy says. They're 30 and 28 now, “but back then they dropped out of school. There are things that have happened over time that I know affected them.”

In December of 2003, the Grassette family finally got an apartment but were unable to access their stored items to furnish it. The shelter gave them a mattress and while Amy called furniture places in the area, she had no luck, not until 1-800-mattress delivered two twin beds. She wanted to give back to the health center at UMass that had been so important to her. She became the clinic’s volunteer project coordinator. It was a 20-hour-a-week position. She quickly was promoted to do more. ‘From the time I was there we had a lot of donations. I started sending emails to staff whenever we had a patient in need. Whether it was a crib or a coat – people were very responsive.’

Amy has worked at the center for 14 years but she is far from settled in. Her latest focus: helping the city that helped her by addressing drug addiction and homelessness.

Last year, there were 37 people who died on the streets in Worcester, MA. “We’ve lost a lot of people to drug overdoses. We have lots of treatment programs but it’s hard for folks to trust to get into our programs,” Amy says. “People that are mentally ill a lot of the times don’t trust us. It could take 6 months or a year to get them into our services. I advocate on a daily basis for our patients and I also advocate within our city.’

Amy knows the pain and suffering and helplessness these people feel. She felt it.

It’s a newly formed group here at the health center that’s trying to eliminate the homeless. ‘We lost the funding for that program…so we encourage people to involve the consumer in the planning of our workshops. We’ve said it a couple of different times that you can’t give services to people without finding out what their needs are.’

But be clear, Amy didn’t wake up one day and say, ‘let me be homeless today.’ She sees this in those she is trying to help. She also is trying to address barriers to help that she encountered. ‘We're supposed to be helping each other but why are so many people not sharing information…there were all these wonderful programs and we didn’t know anything about them.’The mom says she’s become a better person for being homeless. ‘I feel like I have the right to speak up and say that’s not okay. We have homelessness in common but our experiences are different and I want to share my story for those who went through or are going through something like I did.

’This is just one part of a mom’s journey. Just one piece of her life. Amy says if you have the right kind of people surrounding you, you can overcome homelessness.

Solutions

Because of her positive outlook and relentless spirit, Grassette and her family are successful now in many ways but this is not the case for many homeless person. Changing the conversation around homelessness is a necessity for the health of the homeless who continuously go to the emergency department and who don't seek proper treatment because they have bigger challenges. 80% of rural and critical access hospitals report overcrowded emergency departments, filled often times with older seniors who need intensive support but who need to be stabilized or at least get a psych consult first.

"The Homeless in the Emergency Department have a higher general population because it's their primary health provider," says Andrew Franco, MD of Yale New Haven Health.

Franco says health insurers could be doing more to help,"Health insurance could provide more support or incentive to use primary care. They could also reimburse based on metrics for readmission and re-presentation to the ED." said Franco.

"Regarding homeless patients in the ED, CT is unique in that most homeless have Medicaid. This goes a long way towards supporting homeless health, but obviously more can be done. My personal opinion is if CMS money went towards permanent supportive housing (ie housing were to be considered part of someone's health) then there would be more emphasis on health care maintenance (prevention and risk reduction) and fewer patients presenting to the ED in crisis." said Franco.

According to the Agency for the Healthcare Research and Quality, homeless people are 3 times more likely than those with a home to use a hospital ED at least once in a year. Homeless individuals have high rates of mental illness and hospitalization.

At Bridgeport Hospital in Connecticut, there are intervention teams that now meet twice a month to come up with specialized plans for ED patients, each plan molded and shaped for the person. It's proven to decrease ED utilization, says Dr. Franco. The teams are overwhelmed and in some medical records it'll say 'hey, this patient has been here many times.' Franco says this note should trigger a social work evaluation.

Premera health insurance is taking strides to help this issue. In July, Premera granted Covenant House Alaska $1 million to help them fulfill their vision of eradicating youth homelessness. Since opening in 1988, Covenant House Alaska has served thousands of homeless, at-risk, and trafficked youth in the state. The home is providing home, showers, clean clothes, medical attention, and food, they also provide job readiness training, facilitate counseling sessions, as well as music, art, and cooking lessons. Additionally, the staff shows by example how caring relationships are based on mutual trust and respect. Covenant House is working hard to make youth homelessness rare, brief and nonrecurring, and Premera is proud to support them in this endeavor.

Housing saves patients, says Michael Ferry, a licensed social worker with Yale New Haven Health.

‘Lack of housing causes individuals to delay care, see a worsening of symptoms’ Ferry says. “Unless they have a place to recuperate they don’t have the time to get better. I’m a social worker and we’ve begun using electronic medical records different than other hospitals in CT.” Yale uses its records to catch folks that come in, then we send a social worker to meet with the homeless and collaborate with Columbus House, a shelter, to help people recuperate. ‘We worked with Columbus house staff to set up beds on the third floor there, so they could have their own room. Yale New Haven Hospital is pleased with the program and sends its own nurses to the shelter for 40-60 hours a week. Once they’re in the medical rest program patients are one-third less likely to return to the ED. Ferry says there is tremendous improvement in services for homeless patients. He says the cost of Medicaid is reduced to $12,000-$25,000 per month. Once individuals are housed, their need for hospitals drops further.’