“I’ve been left out here to die ever since my legs were cut off,” he said joylessly.
He was a gruff, elderly man, sharp as a tack, bundled in tattered blankets. His below-knee amputations were tucked away in his cramped wheelchair. This man had been street homeless for many years, his primary residence being a dangerous park. He was often attacked, robbed, or pushed out of his wheelchair onto his face, his leg stumps providing little support for his large body. Nonetheless, he was proud and fiercely independent, sitting in his own urine while graciously accepting the now-cold egg sandwich and coffee his devoted caseworker brought him. After a medical history and physical exam, we pushed his wheelchair to a sunny spot of the park to try to stave off the brisk October chill.
Homeless patients with a mobility disability are a vulnerable subsection of an already downtrodden population. Many barriers prevent the disabled homeless from getting sustainable housing, most shockingly, many shelters around Rhode Island do not have enough handicap accessible accommodations. This piece is a call to action to help get the people in the most dire straits into housing more easily. We are currently allowing these people rack up staggering, unpaid emergency department bills every time they fall out of their wheelchairs and hit their faces on the sidewalk or worse. These bills are paid out of taxpayer funds.
When I met this patient as a street medicine physician with his trusted caseworker acting as the liaison, he had not seen his primary care doctor in months and certainly had nowhere to even refrigerate his insulin. His blood pressure was perilously high, and he had multiple abrasions. He did not smoke, drink, or use drugs. It was almost ludicrous to think about medication management and sustainable primary care for a person whose entire life’s belongings were tucked away in a tiny creaking wheelchair. The team of social workers and physicians tried their luck getting him into sustainable housing. This involved his steadfast caseworker from Community Care Alliance Rhode Island sitting with him for six hours during one session, hunched down on the Woonsocket Park’s basketball court’s concrete, making endless and unsuccessful phone calls in an effort to create a solid plan for this homeless man. Unfortunately, many outreach workers and homeless care providers are familiar with this scene.
After hours of calling places, being put on hold, and getting managers involved, she finally found a handicap-accessible hotel room. Now the challenge became transportation. He did not have his ID yet — an arduous, high-level administrative task – so he could not get a bus pass. No ambulance would come to get him. A frontier mental health organization in Rhode Island, BH Link, did not have wheelchair accessible vans. Finally, in desperation, a volunteer layperson arrived with a group of benevolent souls at 7:30 p.m. after working a full day, to lift the homeless fellow into her own personal non-handicap-accessible minivan. At the other end of the trip, the hotel workers helped lift him out of the minivan and wheel him to his new “home.” This laborious coordination fell on the shoulders of his dedicated caseworker.
As he finally got to the hotel, the team was tirelessly working to find more sustainable housing; however, options remained limited due to reliance on a wheelchair. If that selfless volunteer did not have a minivan, a heart of gold, and a team of untrained manpower to lift a grown man into the back of a van, he would have still been sitting outside in his wheelchair in the park, wet and alone. This dedicated caseworker expended multiple days’ of effort on his individual case—something that not every homeless person has the luxury of experiencing. It is absurd that, even when we are finally able to find a stable place for someone who desperately needs it, we cannot reliably and safely transport them. We can be better.
It is important to maintain a housing-first initiative. This is the concept that, when a person gets a place to stay, many things in their life get better. Physical health most assuredly improves as they can store and take medications. Mental stability improves because they do not have to fight for shelter and protection every night. Many amazing outreach workers of Rhode Island organizations (Project Weber Renew, House of Hope, Community Care Alliance, RICares, among others) tirelessly try to find these people housing. However, wait times are long and logistics are sometimes needlessly difficult. Under the Federal Housing Act, “homeless service providers are obligated to provide reasonable accommodations to prospective or current residents with disabilities.” What is Rhode Island doing to help with this? At a minimum, a handicap accessible transportation budget via state grants or at an individual organization level is a priority. This piece is a call to action to help this vulnerable population get the care they require by making handicap transportation and accessible housing more available.
Cara Zimmerman is an internal medicine resident.
Image credit: Shutterstock.com