Care Critical for Homeless
Lack of Treatment for Chronic Diseases Sends Lives Spiraling

By Mary Otto
Washington Post Staff Writer
Monday, October 22, 2007

Vaughn Bell had a job, a good job, working at a rehab center for teens.

He had an apartment, nice clothes, a good life in New York.

Not bad for a guy who, after a difficult youth, lost a few years to drug addiction and prison. The climb back was rough, but he had finally won the struggle.

Then sickness stripped it all away. Everything.

Bell fell ill with kidney disease. Because he was sick, he couldn't work and lost the job. Because he lost the job, he lost his apartment and had to go to a homeless shelter. Because he lived in a homeless shelter, he had to take two trains and a bus to get to dialysis treatments. He fell behind, stopped caring for himself, then just stopped caring.

Late last year, his brother, Amen Ryals, who lived in Walkersville, heard about his plight and brought him home with him. By the time Bell arrived at the dialysis center in Frederick, his feet were so swollen with the fluids his damaged kidneys could no longer process, he could not wear his shoes.

His situation could have become worse: The No. 1 cause of death among the homeless is untreated chronic illness.

Chronic illness does not often, by itself, cause homelessness, experts say, but it's an ingredient in the mix of crushing problems, which often includes troubled personal history or economic trauma. And homelessness has a way of magnifying even a common cold. Without a place to wash, skin lesions fester. Without a safe place to store medicine, diabetes and HIV progress.

"This could happen to anyone very quickly," said Carole Elliott, a licensed clinical social worker at Frederick Dialysis. If health benefits or family supports are shaky or missing, "what do you do?"

The life expectancy for a homeless person ranges between 42 and 52 years, according to Health Care for the Homeless, a national organization that provides free medical attention to the indigent. At 49, Bell is pushing the outer edge.

"Homeless folks tend to live half as long as folks who have homes," said Jeff Singer, president and chief executive of Health Care for the Homeless Maryland. "It's not always because they freeze to death. The major cause is untreated chronic disease."

Research shows an estimated 750,000 people are homeless on any given day in the United States. One-third to one-half of the homeless have a chronic illness, and more than half don't have insurance.

Treatment regimens can be difficult to maintain without transportation or a regular source of food, as Bell found out. "I was sick as a dog," he said.

"He was a train wreck when he came to us," said Kate Seymour, a dietician at Frederick Dialysis. Bell was so discouraged that he was ready to let go. But working with government agencies and local charities, Elliott was able to help Bell get benefits, including medical assistance. And during his three-hour visits to the dialysis center three times a week, the staff worked to get him to start eating right and taking the proper medications.

Most important, Bell said, they convinced him that his life was worth saving.

"It was nothing but love," Bell said. "They talked me back to good health."

That emotional support -- of "bolstering the patient's wounded self-concept"-- is key in helping homeless patients meet the challenges of caring for themselves, concluded a team from the University of Virginia Health Systems Dialysis Program.

The team published a research paper on managing homeless dialysis patients last year after realizing that six of its patients -- or 5 percent of its rural caseload -- were homeless, staying in shelters or their cars.

"If there's a problem, we try to address it. If all of a sudden we have six patients who are homeless, it's hard to ignore," said Thessa Obrero, a dietitian who worked with the local Salvation Army shelter to try to ensure that patients ate food that would not overburden their failing kidneys.

Staying with his brother in Walkersville, Bell found it far easier to eat right and keep up with his dialysis treatments. But then late in the summer, Ryals lost his home to foreclosure. He decided to head out West and begged Bell to come along.

But Bell decided to stay, clinging to his dialysis and his supportive community at the center.

"I didn't want to go nowhere else and risk it."

At Frederick Dialysis, Bell's social worker tapped into local homeless resources and emergency National Kidney Foundation housing funds to get Bell quarters in a motel until space became available in a shelter.

Agencies across the region are trying to help those with chronic illnesses bridge the gap between their homelessness and their medical needs. Montgomery County's main emergency shelter for men in Rockville will begin to remain open during the day starting in January. In addition, the facility is being enlarged to include a medical clinic.

At the Volunteers of America shelter in Woodbridge, Gayle Sanders and her staff work with families and nursing homes to help homeless people who are sometimes too fragile to stay at the shelter.

"We really need something that's between a shelter and a nursing home," Sanders said.

In the District, there is Christ House, an unprepossessing brownstone on Columbia Road that is also a 24-hour health-care facility for the homeless.

Some patients are referred there from hospitals and others by Unity Health Care, which operates clinics in homeless shelters across the city. Nurses and doctors live at Christ House, along with patients who stay and mend for as long as their illnesses require, getting food and rest as well as medical care and social services.

On one recent day a procession of men, many using canes or walkers, made their way down a hall after eating a nutritious lunch. Darryl McCallum, 46, who has advanced AIDS, was among them. He was very thin when he arrived in late July and very sick.

"I wasn't taking my medication. I had nowhere to keep it if I had it," McCallum said. But now he is feeling much better.

"They have been taking good care of me," he said.

As for Bell, he now has a place at a transitional shelter run by the Frederick Community Action Agency, where he stays busy applying for affordable housing and preparing his own meals.

"I am not lucky," he said, "I am blessed."

He is on a three- to five-year waiting list for a kidney, hoping to become strong enough to finish his college degree and return to youth-counseling work.

With good care, his health is steadily improving, he said.

"There are no more spots on my body. My health is better. My diet is better. My life is getting better," Bell said. "It's a blessing to know the right thing to do, and to be able to do something about it."

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