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Old-Fashioned House Calls For The Once-Homeless

Homeless people often have health problems only made worse by living on the streets. After all, it's tough to manage your diabetes when you're eating out of Dumpsters. Or to take your blood pressure medicine if someone steals it while you sleep.

So Boston Health Care for the Homeless is finding apartments for its sickest patients in hopes their health will improve once they have a place to live. And it's doing old-fashioned house calls to make sure they're adjusting. But surprising problems can arise when a long-time street person finally has a home.

ENGINE SOUND OF CAR DRIVING ALONG CITY STREETS

JIM BONNAR: "It says that Mount Pleasant Avenue is off of Blue Hill."

JILL RONCARATI: "Online here it says just to go to Dudley, Dudley Street."

Jim Bonnar and Jill Roncarati are a little lost. Jim is a psychiatrist, Jill is a physician assistant, and they're driving around Roxbury. They're looking for the new home of a woman named Sharon who just moved in. Before that she lived at a homeless shelter. And before that, on the streets.

JIM: "So Mount Pleasant is going to come into Blue Hill Avenue up here. Oh, it's right there — look at that."

Jill and Jim work for Boston Health Care for the Homeless, which gave Sharon medical care when she slept in cubbyholes around North Station. The group helped Sharon get this apartment. She needs it because she has severe liver disease caused by hepatitis C and heavy drinking. Today Jill and Jim are worried because someone talked to Sharon by phone and said she sounded drunk.

SOUND OF DOOR OPENING

SHARON: "Did I sleep too late again?"

JIM: "Hi, Sharon."

JILL: "How you doing?"

SHARON: "All right."

The studio apartment is packed with furniture, a TV, and framed photographs on a mantle. It's so cozy and homey you wouldn't guess it was vacant just a few days ago.

JILL: "So how are you feeling?

SHARON: "Um, today, just tired. I think it's the medicine. But otherwise I feel pretty good."

It's obvious Sharon is sick. She's 39 but seems much older. Her stomach is so distended she looks pregnant. She's bloated like this because fluid leaks constantly from her liver into her belly. She goes to the hospital twice a week to get it drained. Jill asks Sharon if she's been eating.

JILL: "You were going to go to Women's Lunch Place today?"

SHARON: "It was too cold to walk at that time. And I'm like, well, I can't go. I don't want to go. It's too cold."

So Jill tells Sharon where to catch a bus. When Jill and Jim make these health care visits, this is the kind of non-medical help they often provide: arranging transportation, getting bus schedules, making sure patients are fed. They're simple things that can overwhelm former street people.

JILL: "Can I ask a question? So, Denny was actually worried you might be drinking a little bit."

SHARON: "No, would you like to do a Breathalyzer?"

JILL: "No, no — I'm just asking. I'm just asking."

SHARON: "No, honey — I'm not, no."

Sharon explains she sounded groggy because she had just woken up. After we leave, Jill and Jim say they think they believe her.

SOUND OF DOOR KNOCK AND DOOR BEING OPENED

JILL: "Hi, Grant. How are you?"

The next stop is an apartment near Codman Square where a man named Grant moved in just an hour ago. He's 45 and gaunt. And while Sharon's place was lovingly cluttered, Grant's is mostly bare. He says the only clothes he has are what he's wearing. That makes his warmest item a hooded sweatshirt. He has no luggage, just two small bags. A plastic grocery bag contains his toiletries. A paper lunch bag holds his pills and vitamins.

JILL: "Do you have to go over any of your medications?"

GRANT: "Oh, yeah, I should actually try to figure out what I have to take."

SOUND OF PAPER BAG CRINKLING

There are nine pill bottles in his bag.

JILL: "All right, so let's see what we got. This is Benadril, so that's for sleeping or itching?"

GRANT: "Probably both."

JILL: "This one's for your kidneys. That's once a day. This one's twice a day; this is for your belly, the gastritis. And this is for your anxiety and depression."

Grant is clearly startled by this sudden change after about twenty years on the streets. He says he's a recovering alcoholic who drifted into homelessness, collecting cans for money and getting clothing from a donation van.

GRANT: "It's going to take at least a couple weeks to get used to this is what people actually do — live like this! They don't live in alleyways, they don't live down in shelters, and stuff like that, you know?"

But Grant thinks having a home will stabilize him and improve his health.

GRANT: "If I have my own place I'll be able to take my medication every single day and don't have to end up in emergency rooms too often, you know what I'm saying? You know? I'm getting sick of emergency rooms and hospitals and places like that."

The ER is a place homeless people know well. Many patients treated by Boston Health Care for the Homeless are regular visitors to emergency rooms. That's a huge expense for government healthcare programs. Homeless people also often die young of common illnesses that could have been managed with medication. James O'Connell is president of Boston Health Care for the Homeless. He says anything that gets street people housed and healthy is worth trying.

JAMES O'CONNELL: "Something as simple as diabetes, which requires a good diet, exercise, insulin if you need it. If you're on the streets it's almost impossible to do any of those things. You eat what you can but it's usually not nutritious, it's usually high fat content."

O'Connell says visiting people in their homes makes it easier to treat health problems. It gives health workers a better understanding of their patients.

O'CONNELL: "Honestly, we're looking to see how people are doing after years on the streets. How are you making out in your new housing and are you able to cook? Are you eating? You can see if people are losing weight or gaining weight."

The health care teams also address new health problems that can emerge once former street people have roofs over their heads. That's why psychiatrist Jim Bonnar was added to the team, thanks to funding from Massachusetts General Hospital. Bonnar says the visits sometimes reveal that patients aren't doing well even when they say they are. He says unexpected mental health issues such as anxiety and loneliness are common.

JIM: "Some people love to have a home and they start to decorate it and they take pride in having this nest. Other people go in and two weeks later there are no chairs, the bed isn't made. We found a guy lying on a deflated air mattress on the floor with no furniture in the place with a blanket over him."

SOUND OF DOOR OPENING

JILL: "Hello. Hi, David."

The last stop of the day is in Jamaica Plain. Jill and Jim visit a 65-year-old formerly homeless alcoholic named David. They want to check if he needs his prescriptions filled. Ashtrays are scattered around the crowded studio apartment and there's a mouse trap on the floor. David settles into a stained armchair, pushing aside a soda bottle, cigarettes, and rolling tobacco. He has emphysema and chronic bronchitis worsened by smoking, and he wheezes audibly as he talks.

JILL: "David, are you using your inhalers at all?"

DAVID: "I haven't been, no."

JILL: "How much are you smoking now?"

DAVID: "About a pack a day. But I gotta get rid of that again."

JIM: "You're at risk for pneumonia."

DAVID: "What's that?"

JIM: "You have a high risk for getting pneumonia if your lungs are all blocked up."

DAVID: "Really?

JIM: "Yeah."

Boston Health Care for the Homeless hopes it will save lives by making these house calls. But the organization knows not all its patients will make it anyway. In fact, six of the first 24 people to receive housing eventually died. But the health care teams say at least they died safely indoors instead of on a park bench or under a bridge.

This program aired on February 26, 2009. The audio for this program is not available.

Sacha Pfeiffer Twitter Host, All Things Considered
Sacha Pfeiffer was formerly the host of WBUR's All Things Considered.

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