Doctor’s Orders: New Program for the Homeless Pairs Healing with Housing
Daniel Garelick, 45, sits quietly in his wheelchair, calm despite the bustle surrounding him at the OPCC Annenberg Access Center for homeless people, in Santa Monica. He breathes slowly, and every few seconds a slight “whoosh” emanates from an open wound on his right side. Garelick had a lung removed during a recent 13-month stay in a local hospital, and the one he has left is leaking air into his chest cavity.
“If I didn’t have this hole,” he says, “my chest would fill with air and explode.”
But he does have a hole. And until his lung stops leaking, that hole cannot be sealed.
Like many patients discharged from hospitals, Garelick needs a clean, stable place to recover. He knows this is no time to be homeless.
“With an open wound,” he explains, “sleeping in one of the city parks isn’t an option.”
Fortunately, next door to the Access Center at OPCC’s Samoshel, Garelick now has his own bed. And every weekday morning, just steps from that bed, he visits a physician from Venice Family Clinic, who cleans and redresses his wound.
It’s all part of a pilot project called the respite care program, wherein Venice Family Clinic and two local hospitals, Saint John’s Health Center and Santa Monica-UCLA Medical Center and Orthopaedic Hospital, refer homeless patients in need of recuperative care to OPCC, which provides room and board, as well as case management and housing assistance. Venice Family Clinic then provides on-site medical care.
Traditional overnight shelters require that homeless individuals leave in the morning and live on the street during the day. But the ten beds set aside at Samoshel – five for men and five for women – are available around the clock. For those enrolled in the program, Samoshel becomes their home while they heal.
The goal of the project, funded by the Los Angeles County Homeless Prevention Initiative and the Tides Foundation, is to reduce unnecessary, costly re-hospitalization among members of the local homeless population. The homeless are frequent users of emergency services, in large part because the struggle for basic needs often diverts their attention from compliance with medications, physician instructions, and follow-up appointments.
Along with those discharged from local hospitals, many of the program’s patients, like Garelick, come to the Access Center off the street and are referred into the respite care program by Venice Family Clinic’s medical staff. Now in its second year, the program almost always operates at capacity.
“Being able to follow doctor’s orders makes a big difference in a patient’s recovery,” Theresa Brehove, MD, Venice Family Clinic’s Director of Homeless Services, explains. “Bed rest is often the foundation of an effective treatment plan.”
Dr. Brehove alternates days at the Access Center with her counterpart, Dr. Coley King, who also makes rounds on Venice Family Clinic’s Street Medicine Program, in which he and staff from OPCC visit homeless people on the street and encourage them to accept help from one or more of the various public and private agencies that offer assistance.
There is a natural fit between Venice Family Clinic and OPCC, so much so that when OPCC built the Access Center, in 2007, it set aside two exam rooms specifically for Venice Family Clinic. Through this expansion, clients could receive medical care at the same time that they visit for other homeless support services, including meals, showers, lockers, mail pickup, and crisis counseling. The respite care program expanded upon this partnership in 2008.
Dr. Brehove carefully talks each of the eight to ten patients she sees each morning through the steps of their treatment, knowing that seeking medical care is not something that comes easily for many homeless people. Garelick was more receptive than many.
“I never really considered myself homeless before,” he acknowledges before seeing the doctor. “But now, I’ve come to terms with it and thank God every day that I have a roof over my head while I get better.”
For patients like Garelick, the respite care program can also be a springboard to a profoundly different life. If they consent, homeless patients are linked to OPCC case managers who begin the search for permanent housing.
As of June 2010, the respite care program has treated more than 140 patients; in the first year alone, 31 were placed in apartments, transitional housing, or care facilities, or they were re-united with family.
Myra Castillo, Venice Family Clinic’s Medical Assistant at the Access Center, reflects on the impact the program has had in a little more than a year. She smiles at the memory of a recent patient who returned to say thank you.
“We almost didn’t recognize him, he looked so good,” Castillo says with a laugh.
While taking Garelick’s vitals, she explains that every patient has a unique set of needs and history. Being homeless might not be the only battle they are fighting. Many face additional challenges from mental illness or addiction.
“This was my last straw,” Garelick says quietly, putting his hand to his wound as he speaks. “I can honestly say I don’t know what I would have done without this program.”
Contributed by Krissy McBoyle. Krissy is a Venice Family Clinic intern and a graduate student in the USC School of Policy, Planning, and Development.