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The roughly 160,000 undocumented immigrants in Massachusetts do not have access to most public health insurance programs. Some doctors and nurses in Boston have noticed this can pose particular challenges at the end of life, where the undocumented do not have access to nursing facilities or hospice care.
Some health care providers are stepping in to help these undocumented and dying individuals.
'This Place Is Special'
“How's your breathing been feeling?” the nurse asks. “Take a deep breath. Has the pain gotten any better?”
“Yes, I tolerate it better,” Kervin Alleyne says, reassuring his nurse that the bone pain he feels is manageable.
Alleyne is dying of metastatic prostate cancer, but he is not one to complain.
He looks around the room at the three other hospital beds, and then out the window to the concrete and traffic of Boston's South End.
“One of the best places that a person could ever be,” he says. “This place is great. This place is special. Trust me. Trust me.”
Before arriving at this special place, Alleyne was staying in a homeless shelter.
But for the past year he's been at the Barbara McInnis House. It has over 100 medical beds for homeless individuals.
“We help individuals who are too sick to be in shelters or on the streets but not sick enough to actually warrant a medical bed in a hospital,” explains Denise De Las Nueces, the McInnis House medical director.
Usually homeless patients are discharged after about a dozen days — when they are healthy enough to go back to the streets.
But what about homeless patients who are dying?
Making An Exception
If the patient has citizenship or immigration documents they usually go to a nursing facility or a hospice.
But Alleyne, who is 67, is an undocumented immigrant from Trinidad. That means he is largely barred from public health insurance options and can only get access to emergency services.
De Las Nueces says for the undocumented and dying, the McInnis House has started making an exception because the patients have nowhere else to go.
“We really provide end-of-life care for individuals who really have no other options in terms of where they can have a dignified death,” she says. “And many of those patients are individuals who are undocumented and therefore have limited insurance or no insurance at all.”
De Las Nueces says this isn't too common, but there has been a steady trickle of undocumented, homeless and dying patients.
This prompted the whole McInnis House medical team to get end-of-life care training.
Cheryl Kane, the director of nursing at the McInnis House, says the medical staff often provides more than just medical care.
“Things the family members might usually do, we take on that role,” she says. “What are your wishes at the end of your life? Setting up the cremation form, working with the funeral home. Maybe where family members might sit with the patient when somebody is actively dying, we do that.”
Kane says it's an honor to provide such care but ultimately hopes these individuals will have somewhere else to go.
Immigrant activists say it’s unlikely that undocumented immigrants will gain access to public health programs soon. Advocates are currently focusing their resources on maintaining the right of documented immigrants to access state health insurance.
Kervin Alleyne says given that he is undocumented, homeless and terminally ill he feels blessed to have found a place to stay and to die.
Correction: An earlier version of this report misspelled Kervin Alleyne's last name. We regret the error.