Homeless, aging and ill: Respite programs can be a lifesaver, but space is extremely limited

YAKIMA, Wash. – Early one morning in March, 78-year-old Bob Davis was found wrapped in blankets and cardboard outside The Depot, a homeless services office in downtown Yakima.

“He was laid up in our doorway,” homeless outreach worker Robin Perches said. “He wasn’t very functional. He was like: ‘I’m cold, I’m very cold and I can’t get up.”’

Davis, who has dementia, couldn’t remember who dropped him off or where he had last been. He told Perches he had a broken hip and she called an ambulance.

It turned out Davis’ hip wasn’t broken, although he did undergo hip surgery last year. He was hospitalized for two weeks with a skin infection, but the hospital kept him for a month because he was homeless and had no place to go.

Eventually, the hospital sent him to the Union Gospel Mission, where he was rejected because the facility wasn’t equipped to care for him.

He was returned to the hospital where a police officer then removed him from the lobby and dropped him off at The Depot, which is run by Yakima Neighborhood Health Services.

Since then, Davis has been in Neighborhood Health’s respite care program, which provides him with a temporary apartment, a registered nurse and caretakers.

Davis is part of a growing aging homeless population that is often in need of medical help in the Yakima Valley, where a service shortage sometimes can lead to death. This year alone, three homeless people over the age of 52 in Yakima County died of illness or exposure.

This segment of the homeless population is growing locally and nationwide, and now has come into sharper focus.

“The number of homeless seniors is increasing,” said Rhonda Hauff, Neighborhood Health chief operating officer. “Homeless baby boomers are getting older. That is a concern and not everybody is qualified for nursing homes.”

Without a primary care provider, aging homeless people often resort to emergency room visits, a scenario that drives up costs and can stress hospital staff who scramble to find a safe place for them to go after being released – sometimes a daunting task.

If they end up back on the streets without care during their recovery, they soon end up in the hospital again or even die.

Neighborhood Health is the only service provider in Yakima offering residential respite care, a hospital official said. But it has just six beds and often falls short of meeting the area’s demand, added Hauff.

Last year, the agency was forced to turn away 28 people in need of respite care due to a lack of space, and another 20 because their conditions were too severe and needed medical attention, she said.

Davis is one of the lucky ones – a bed was available when police brought him to The Depot, and now Neighborhood Health is securing him a place at a long-term care facility.

Bob Davis

One recent morning, Davis sat quietly in the small kitchen of his temporary apartment in the respite program. Caretaker Jesus Campos carefully tamed his gray hair with clippers. Nurse Jeanette Villanueva then shaved his beard.

Davis said he was originally from Arkansas, but couldn’t say how long he’d been in Washington or why he came here. He used to work in fruit warehouses here, Davis said.

He quickly became bothered by questions from a Yakima Herald-Republic reporter.

“I can’t keep answering all these questions,” he said in an ornery voice.

But when Villanueva and Campos asked him if he liked it when they visit, a small smile emerged as he said “yes.”

They asked him to name his favorite snacks and food.

Coco Puffs cereal, chocolate candy and spaghetti, he said.

Dementia can cause memory loss, mood swings, disorientation, faulty reasoning and a lack of self-care.

When Perches first saw Davis, his beard and hair were disheveled and his fingernails were several inches long.

“We work with a lot of people who are outside who have health problems, but what was the really hard thing about Bob is he’s elderly and it’s hard to see someone who should really be taken care of out on the streets,” Perches said. “It’s really heartbreaking.”

Campos and Villanueva have built a relationship with Davis through patience, they say.

At first, he wouldn’t let Villanueva clip his nails. She backed up – OK.

Moments later, he allowed her.

“When you push people, they push back,” Villanueva said. “Being patient is the most important key.

His behavior has gotten better and it’s gotten easier as time has gone on.”

Elderly on the streets

An aging homeless population has been growing nationwide.

In 2007, homeless people age 62 and older who sought shelter accounted for 2.9 percent of the country’s homeless population, but that had grown to 4.7 percent by 2016, according to estimates from the National Alliance to End Homelessness.

Although local and statewide statistics on elder homelessness weren’t readily available, an increase in need for respite care was one of the focal points of the 2018 Conference on Ending Homelessness held in Yakima this week.

There have been tragedies here. In February, a 67-year-old homeless man was found dead, possibly due to exposure, at Kiwanis Park near East Maple Street, Coroner Jack Hawkins said.

Earlier this month, a 67-year-old man who left a nursing home died of health issues at Camp Hope, a homeless shelter in Yakima. Also this month, a 53-year-old homeless woman was found dead in a Toppenish parking lot by Yakama tribal police, Hawkins said.

“They were familiar with her and knew that she was sick,” he said.

Hawkins said he’s waiting on results of toxicology reports before determining a cause of death in those cases. But he’s concluded that illness combined with being elderly and living on the streets are contributing factors to these deaths.

Nicole Williams, who manages outpatient coordination at Virginia Mason Memorial, said the hospital treats homeless people with severe issues about once a month, and has to look outside the community for temporary housing for about half of them.

“From the minute they come in, we try to find a safe place for them to go,” she said. “That’s when we have to start looking out of town. It would be great if (Neighborhood Health) had a few more beds.”

Respite care is designed to keep homeless people out of hospitals by giving them a safe, clean place to recover from medical treatment, Hauff said.

When her agency began the program nearly 12 years ago, most of the referrals came from hospitals, but that changed over time as her agency began connecting homeless with medical services providing preventative care and the bulk of referrals began coming from doctors and health clinics ahead of hospitalization.

But with the rise in elderly homeless, Hauff said the program needs expanding. It operates on a $150,000 annual budget, and includes six apartments, a nurse, caretakers and mental heath services. Neighborhood Heath’s respite program typically houses people for 28 days before moving them into long-term care or housing.

There are only about 90 respite care programs for the homeless nationwide, said Bobby Watts, National Health Care for the Homeless Council chief executive officer.

Reports of a recent study show respite care programs have cut hospital costs – and losses – by hundreds of thousands of dollars annually in communities where they operate.

In Chicago, for example, respite care paired with permanent supportive housing reduced hospital stays by 2.7 days, reduced hospitalizations by 29 percent and emergency room visits by 24 percent, according to a Journal of Health Care for the Poor and Underserved report.

There would be more respite care if Medicaid would cover it, Watts said. Some states, such as California, have decided to fund respite programs understanding that it reduces stress on the medical system as well as helping the elderly in need be healthier.

“We just know that the need for medical respite is great,” he said. “Wherever it has been established, it has proven successful by all concerns. I’ve never heard anybody say ‘oh I wish we never created that medical system.’ ”