Safe and Secure
A new initiative helps the homeless manage chronic health conditions – from home
By Kate Morgan

If you ask Alfred Borden which part of his home he likes best, he’ll tell you the kitchen. That’s because he went to culinary school and simply loves to cook. But that’s not the only reason. For more than a year, Borden lived on the streets, getting his meals from food pantries and homeless shelters.

Borden, 49, now has a kitchen – and home – of his own, thanks to a new initiative focused on providing housing for homeless people who are frequently hospitalized. Organizers of the Housing First program believe a stable home will help this population live far healthier lives.

Borden has been diagnosed with heart failure, so it’s essential that he takes medication, sees his doctors and develops healthy habits – none of which is easy to do when you live on the streets. Having to miss work because of his illness is what caused him to lose his job and eventually his home. It was a huge blow, but Borden says he is a survivor.

“I’ve been sick a lot, always in and out of the hospital,” Borden says. “Last April, homelessness hit me. I was staying with different people and in the shelters. It was hard to get my medicine and to get to my appointments. It was even more difficult because of my diet. It was really bad, and that negatively affected my health.”

Dr. Jeffrey Brenner

Dr. Jeffrey Brenner

Borden’s situation is common. Jeffrey Brenner, MD, medical director of the Urban Health Institute at Cooper University Health Care and executive director of the Camden Coalition of Healthcare Providers, which runs the housing initiative, says about 25 percent of the patients seen at area hospitals are homeless.

“Nothing we do works if they don’t have stable housing,” Brenner says. “It’s hard to take your medicine, take care of your body and move your life forward if you’re sleeping on a bench, in a tent or on a cot in a shelter.”

As a result, many of these patients quickly find themselves making frequent visits to the emergency room. The coalition works with those who have had two or more hospital admissions over six months, but Brenner says most are hospitalized far more often. He was inspired to bring the program to South Jersey when he saw the success of the model in Trenton.

“It started in New York City and has spread across the country, popping up in parts of New Jersey,” Brenner says. “We were really inspired when a team in Trenton worked with someone who’d been in the emergency room 450 times. They got her into stable housing, and her ER visits dropped to 18 times a year.”

The program works by using a health information exchange between local hospitals to identify homeless patients who’ve been admitted at least twice in six months. Coalition representatives begin to work closely with the patient, helping them make and keep appointments for medical and social services. Though it can take months, the goal is to secure a Section 8 housing voucher and find appropriate housing.

In the three months the program has been up and running in South Jersey, Brenner says seven patients have gotten vouchers and been moved into new homes. More than 20 are currently in the application stages for housing.

With the program’s success comes financial savings for taxpayers and a reduced drain on local and regional resources, according to Brenner.

“There are a number of benefits to the program,” he says. “It reduces hospital emergency room costs, makes the streets of Camden safer and calmer, and reduces the use of the jail and police department as a social service agency. If you’re homeless, you can complain of chest pain and get three days at Cooper, where you’ll be fed and sleep in a bed. If you get arrested, that’s another week with three square meals. When they’re filling shelters, hospital beds and jails, we’re wasting a lot of professional time and money. It’s much cheaper to get people into apartments.”

Beyond the financial benefits, Brenner says he is driven to expand the program because of the human element involved in getting people back on their feet.

“I think once you’ve seen it work for one person, and you see the human story, you just can’t get it out of your mind,” he says. For Brenner, that first person was a man who was sick, struggling and isolated.

“He was a white male in his mid-40s who’d grown up in the ’burbs,” Brenner says. “He was a construction worker who injured his back and ended up on pain meds. Soon he was an alcoholic with lots of medical problems and totally estranged from his family. Now he’s in an apartment, and he’s putting his life back together. He’s getting clean, and he even had his grandchildren over for the holidays.”

Borden says he understands firsthand that homelessness is a nearly inescapable cycle. Without help, he says, he would almost certainly still be on the street.

“I didn’t know where to go or how to sign up for low-income rent,” he says. “I didn’t know how to find a place. You’re too worried about getting to the doctor, figuring out where you’re going to stay that night, how you’re going to eat. I was totally on my own, carrying all my clothes and medical records around with me from place to place.”

In January, Borden moved into an apartment in Collingswood. In the weeks since, he says his health has drastically improved, and he’s getting back to the life he led before homelessness.

“I’m still adjusting, but I’m doing a lot of stuff I couldn’t do before,” he says. “I’m making my doctor’s appointments, going shopping, just taking care of my health so much better. I have to eat certain foods, and now I can make my own diet. I’m shopping and cooking for myself.”

“I’m a very musical person,” he continues, “so it’s nice to have somewhere I can just sit down on a couch, have some ‘me time’ and listen to some music. I’m thinking about that instead of worrying about if it’s raining or how far I have to go for my next place to sleep.”

To help Borden and the other patients who’ve been housed by the program adjust to their new living situation, members of the Camden Coalition, along with people from other community organizations, frequently check in with them.

“A lot of them haven’t lived anywhere for years,” Brenner says. “You forget how to buy groceries and pay bills. We work with community partners to mentor them into independent living, how to be a good neighbor, how to take care of themselves and their apartment.”

Brenner has no intention of slowing down. The initiative presently has 50 housing vouchers to distribute, and once those are gone he says he’ll just work to get more. Brenner estimates there are between 400 and 600 chronically homeless patients in the region, and he plans to find a home for every one.

“This is the most gratifying thing I’ve done in my career as a physician,” Brenner says. “I’ve never seen anything work as well. You simply cannot help people if they’re not housed. I would hang up my stethoscope and go first for the apartment keys. Housing really is the best pill.”

April 2016
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