Seattle program helps comfort homeless people in their final days
There are nearly 4,000 homeless people on the streets of King County.
We know they don’t have a place to live. What most of us don’t realize is they also don’t have a place to die.
“All of them that are not housed really don’t have a place to die. We have people dying on the street all the time,” said Tricia Madden, program director for University of Washington School of Medicine’s Palliative Care Outreach program at Harborview.
The first of its kind in the nation, the homeless program offers mobile treatment and care to people on the streets dealing with terminal illness.
Palliative care is traditionally thought of as treatment for parents or grandparents. However, Dr. Daniel Lam, director of medical care for the program, says they are treating people in their 40s and 50s.
“Chronic homelessness exacerbates the serious illnesses all of us face,” Lam said. Someone around 50, for example, is essentially a 70-year-old if they’re homeless.
Tony Boxwell, a nurse practitioner who visits and cares for the homeless, says he met one man who had lived in his van in SoDo for years and arrived in the ER in so much pain he couldn’t walk. The doctors found lung cancer, which had spread throughout his body. Boxwell provided him treatment in his van because he didn’t qualify for a nursing home.
“Even when the cancer metastasized into his femur … it broke and he had to have a steel rod put in it, he wasn’t able to go to a nursing home to recover from that surgery, he went back to his van and we took care of him from there because he had a felony conviction,” he said.
It’s a common problem. Many homeless may medically qualify for assisted living but won’t qualify for housing assistance. It’s a dizzying system to confront. And comfort and relief from pain at the end, that’s something you need money for.
“As he was approaching the end of his life, his desire was to take advantage of the Death With Dignity Act we have here in Washington,” Boxwell said of the aforementioned man. The act allows someone to have a place to die and someone with you when you take the $3,000 lethal dose of medicine. “And you have to come up with the cash. He’s too poor to die. Death was not even an option.”
It’s that type of patient the program reaches out to. Providing medications, specialized care, a familiar friendly face, and something to help patients get through each day.
“You know when we first meet somebody, we don’t think how are we going to plan for you to die, we think how are we going to get through today and what is it you want and are hoping for,” Boxwell said.
But sometimes even cancer isn’t the worst thing these people face in a given day.
“Cancer wasn’t the worst thing that happened to [the man in the van] that day because somebody broke into his van and shot him in the head, and that’s how he died,” Boxwell said.
It doesn’t always go that way — a cancer diagnosis can sometimes be the best thing that can happen. Some patients go from living on the streets to surviving cancer treatment and finding housing, Boxwell says. They’re in remission and their lives are completely different.
The program makes financial sense as well, cutting hospital stays for the patients by twenty-five percent and emergency room visits by fifty percent.
However, running on a limited budget set to expire in 2017, the program can’t help everyone in need. The homeless are at further risk should the Affordable Care Act be repealed by the Trump administration.
Lack of insurance isn’t the only barrier to accessing health care. Boxwell says one of the patients he visits feels too ashamed to visit the hospital.
Dr. Lam believes an ideological change is needed — where society acknowledges health care as a basic human right.
Joe Huffert, a nurse with the program, says while they will be there to help as many people as possible, a housing first model is the best overall solution.
“Ideally, our group and a lot of groups like ourselves would rather see us as obsolete,” he said.
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