Posted on May 8, 2012
This blog was written by Georgi Fisher, case manager for HomeLink, a program of Virginia Supportive Housing.
For as long as I’ve worked in social work, I’ve had a difficult time grasping the idea of “housing readiness.” The idea behind housing readiness is that a person who is homeless should first conquer his or her demons and prove that they are ready for and, have in turn, earned the right to housing. While most homeless programs have operated off of this philosophy, this premise is one that homeless service providers have wrestled with for years. I’m not sure about you, but no one ever made me prove my ability to cook, clean, never make poor decisions, pay bills on time, and be the overall picture of perfection before they allowed me to have a roof over my head . If they had, I’m more than sure that I would never have been granted access to an apartment during my 20’s and probably never would have been given a house in my 30’s.
Virginia Supportive Housing subscribes to the “housing first” model, which focuses on bringing people directly from the street and into their own apartment. In this model there is not a period of transition from the street to a shelter, from a shelter to a transitional program, and from a transitional program to an apartment where a person has to earn their right to permanent housing. Here, the primary focus is to put an individual into permanent, stable housing right away. And this is where my role at Virginia Supportive Housing comes in. My name is Georgi and I was hired to work as a case manager for a brand new program within Virginia Supportive Housing called HomeLink. The HomeLink Program is one that was started to identify and house those most at risk of dying on the street. Since I first began to work with this program, many people have asked me why we put people into housing without asking them to clean up their credit, get a job, stop using drugs, follow directions, or otherwise be perfect. In the beginning it was difficult to answer this question, other than by just saying “because it’s right.” And then I met John.
John was one of my first client’s in the HomeLink Program and our first meeting was in the downtown Social Services building. I walked into the room and was met by a frail younger man wearing a heavy army coat and a hat that was pulled down over his eyes. The distinct odor of days without access to a shower and alcohol met me as I pulled a chair next to him. I introduced myself and John, without saying a word, slowly looked me up and down with a skeptical look on his face. He then said, “You and I aren’t going to get along.” Trying not to look taken aback, I smiled and said that was ok. The conversation didn’t necessarily go well from there. John was skeptical about my program and the fact that I was offering him housing with no strings attached. Several times during the first meeting he got up to walk away and I gently coaxed him back into the chair to talk with me. After an hour passed, we wrapped up our conversation and I asked John if he would want to go look at an apartment. He again looked at me with a bit of shock and skepticism, but advised that he did want to look at an apartment and we agreed to meet the next morning at a corner he liked to hang out at downtown.
The next day arrived and I pulled up to the corner to find my new client even more frail than the day before. His thin body was no longer wrapped in a heavy coat and the skeletal outline of his body was shocking. John seemed a bit more relaxed and opened up to tell me more about his history. He explained that he had been on the street for nine years and that he had been battling addiction. He also disclosed that, because of his addiction, he had burned many bridges with people in his life and that he had made the decision to separate from friends and family in an effort to protect them from further hurt. The shame was glaringly evident as he spoke quietly in the car next to me, head down and gaze pointed at the floor board of our van. After looking at an apartment, we set a date for John to move in just a couple of weeks away. He was quiet, but excited, and still a bit skeptical.
As I was driving him back to the place where he would spend his days, he disclosed that he had been feeling quite ill for weeks but did not want to go to the hospital. John, I knew, had AIDS and had, many times in the past, battled serious illness as a result of being on the street and not accessing proper nutrition or medical care. I offered to take him to the hospital to be looked at but he declined, saying that he did not like hospitals. I gave him my card and told him to call me if he changed his mind. Several days passed and John continued to decline to go to the hospital. Then, one night, right before I was leaving the office, I received a phone call from him saying that he would go. I immediately drove to pick him up but as we reached the hospital he, again, changed his mind. I offered to buy him a Frosty from Wendy’s and sit with him in the Emergency Room while he was evaluated. Looking surprised, he agreed and there we sat for hours, waiting for him to be seen. There were many strange looks as people walked by and saw me, dressed in my work clothes and John, dressed in his dirty army coat and stocking cap, sharing dinner and conversation together.
I imagine that John knew, in his heart, that if he went to the hospital he might never get to come back home. He had battled with severe pain and nausea for weeks but never wanted to go to the hospital because of fear of the unknown, denial, and, on a deep level, fear about how people would treat him knowing that he was homeless, an alcoholic, and HIV positive. John was admitted into the hospital that evening and, for the next two months, he remained there. Battling sepsis, an infection in the blood, and meningitis, John lay weak and in pain in his hospital bed. Every day I, or one of the two social workers on my team, would go and sit with John. We would talk about the weather, about his day, about his illness, about his hopes to go to his new apartment, and, toward the end, about the many joys and many regrets that he had about his life.
Always with gratitude, John began to open up about his life. He shared about his long-term relationship with a young woman and the three beautiful children that had come out of that relationship. He shared about how he and his partner battled addiction, he to alcohol and her to heroin, and how their youngest son was born addicted to drugs. He shared the guilt that he and his partner fought with daily about his son’s exposure to drugs. John then shared that their baby boy passed away at just 31 days old due to birth defects caused by his partner’s substance abuse. He spoke about the deep rift that his son’s death had left in his family and how, a few months after the baby’s death, his partner had left him a note apologizing for harming their son and explaining her deep sadness. He found that note and his partner after she killed herself. He described the panic, the despair and the anger that he felt, now being alone with two children. It was there, he explained, that his addiction took a dramatic turn and there that he began to lose touch with the world.
Several weeks after our first meeting, I found myself sitting in John’s hospice room, gently washing and shaving him with another social worker from my team. John was unconscious, now in a coma state, but it was a final act to bring dignity to a man who so many had looked past or given up on. We played Teddy Pendergrass, his favorite musician, on a CD player next to his bed, changed him into a clean gown, and tucked him into fresh linens. For many people, these steps would be carried out by family members enjoying the last moments with their loved one. But for many other people, these moments wouldn’t be shared with anyone. For our clients, their last moments would have been alone, under a bridge or in an abandoned building, without care or comfort and, most likely, without ever being identified after their death.
Having the pleasure and privilege of being John’s social worker taught me quite a bit about life and its value. More importantly, John finally gave me an ability to answer the question that so many had asked me regarding the housing first model – why? Now, I can easily say “because of John.” Without a housing first model, John would have never been identified for intensive case management and would have, most likely, continued to refuse care and treatment. And, though John was never able to move into his apartment, he died surrounded by people who loved and cared for him.
John’s death could have been prevented. With early identification and intensive case management, John could have received necessary treatment and follow up that would have ultimately saved his life. That is why we believe in and practice a housing first model. I now carry a case load of individual’s who are struggling with AIDS, advanced cancer, heart disease, acute kidney failure, mental health and substance abuse, among a host of other medical and psychological diagnoses. Since I started working with HomeLink four months ago, I have buried two clients and am actively preparing for the death of a third. I realize, with every new person that I meet, that the investment in a housing first model will eventually move from providing compassionate end of life care to providing important interventional care that will allow for our client’s survival and reestablishment into the world.
So, housing first is about ensuring survival, practicing compassion, and realizing our own imperfections. Jesse Jackson once said, “Never look down on another person unless you are helping them up.” Every day I know that, when I offer my hand, I am helping another person up.