dr Heidi Behforouz had just met with a critically ill patient at his home – a 58-year-old man who was hospitalized four times in six weeks – and now she was in the building’s lobby.
Through the window, Skid Row lived up to its name. Three men were sprawled on the sidewalk, and Behforouz looked down to see if any of the men in particular need immediate help.
“It never ceases to amaze me,” said Behforouz, medical director of an LA County lifesaving program called Housing for Health. She worked similarly in Boston before arriving in Los Angeles in 2015, and she was immediately struck by what she saw on the street.
“It was horrific, to be honest. The level of devastation is so much greater here than in Boston,” Behforouz said. “People here that I’ve cared for die at a much younger age.”
Her goal is to not only help them survive but thrive, and also to provide street medicine to those who do not yet have shelter. It’s tough, labor-intensive work involving an army of field workers at dozens of public and non-profit organizations.
Around 20,000 people receive this care from Housing for Health, but thousands of people currently homeless could benefit from the same all-round services from this agency and others who provide it, if only sufficient resources were available.
We saw them all out there. The sick, the confused, the addicts – products of poverty, trauma, unaffordable housing and a silo system of often poorly coordinated care. It’s an elusive catastrophe in a state that ranks as the fifth largest economy in the world and is home to internationally recognized teaching hospitals.
Last week I wrote about Sean Sauceda, who is finding success in sustainable supportive living after several years of helping Housing for Health, which has been in operation for a decade. Since then I have followed when Behforouz teams visited the homes of formerly unaccommodated patients with serious illnesses. The goals are to prevent costly hospital stays, returns to homelessness and death.
Elsa Harmon, a registered nurse with Housing for Health, arrived in the morning at the Gardena residence of a 65-year-old patient named Miguel, who became homeless for the first time after losing his job as a machinist. He had just returned from chemotherapy for lung cancer, was throwing up and didn’t feel like meeting strangers. He asked if Harmon could return another day.
It gave me the opportunity to meet Harmon who grew up in Ecuador. We sat in the common room in Miguel’s building and she told me that she was a computer engineer until a career change in middle age, inspired by her daughter who worked as a nurse and shared stories of her challenging but rewarding work.
“Usually kids follow in their parents’ footsteps, but in this case I followed my daughter,” said Harmon, who studied nursing for five years – nights, weekends and days off – while working full-time. She became an RN eight years ago.
“My patients are my passion and it’s great to help people like Miguel,” she said, adding that with a closer look, our perceptions of who is homeless and why can change. “The color of your blood, my blood and everyone else’s blood is the same. You must treat your patients with honesty and dignity. … They cannot be promised that they will live forever, but they can be promised that they will be well taken care of.”
The same day, Harmon reported to the South LA home of Perla Fuentes, who had fled street crime in Honduras with her two grandchildren after her daughter was killed and her home destroyed in a fire. Fuentes said she and the children were arrested at the border and separated, then reunited and temporarily moved into a friend’s house in LA
Fuentes got a job at a pizzeria and rented a room in a house. But cervical cancer, first diagnosed in Honduras, flared up. She lost the job and couldn’t afford the room, but she said she and the kids continued to sleep there, slipping in and out when the landlord wasn’t there.
She became aware of Housing for Health after several hospitalizations, and the family now lives in an upstairs unit in the backyard of a house.
“Come in,” Fuentes said when we arrived. “My house is your house.”
Fuentes sat in an armchair with a blanket covering the lower half of her body. Despite her circumstances, she wore a big smile that led me to believe the prognosis was good, but I was wrong. Harmon explained that the cancer has spread, chemo and radiation treatments have stopped, and Perla’s mother is visiting on a humanitarian visa to help.
The grandchildren, 8 and 10, tinkered in another room and Fuentes’ mum made fruit salad for us all for lunch. Fuentes insisted that we eat and relax while she and Harmon continued, holding hands like longtime friends.
“I trust in God,” Fuentes explained her good mood. “I’m OK.”
“Obviously like everyone, she’s scared,” Harmon said, but she found strength in faith. “With less, any person would end up on the floor. … I can teach my patients about medicines, but they teach me about life.”
Harmon went through Fuentes’ recent symptoms and rummaged through a bag of pill cases to remind her of dosages and upcoming doctor’s appointments. When we left Fuentes asked us to come back anytime.
“My house is your house,” she said again with a beaming smile.
A week later, Behforouz and one of her nurses, Jonah Malana, met me, along with Housing Works case manager Jasmine Salas, at a patient named Micaela Duarte, who lives with her son. In her late 50s, Duarte suffers from multiple advanced heart and lung diseases, as well as diabetes and high blood pressure.
“Sit down,” Duarte offered with a warm greeting. She sat at her kitchen table and motioned to a chair for me. Panting and choking, she told her visitors that family members were visiting.
“I feel blessed,” she said.
The doctor, nurse, and case manager engaged Duarte to the bedside with the same graceful manner that I had seen Harmon engage in with their patient. Duarte seemed relaxed and reassured in her presence, but Behforouz and Malana found her blood oxygen levels were nearly 70, more than 20 points too low.
Duarte attached herself to an oxygen tank while the doctor and nurse noted that Duarte hadn’t used her new BiPap device, which pushes pressurized air through a mask into her lungs. Behforouz noted how confusing it can be for patients to master and become familiar with such devices, and she and Malana set about training Duarte.
It took even the professionals a while to make the connections and fit the resuscitation mask comfortably on Duarte’s face, but during an hour-long visit, the patient’s blood oxygen level rose to over 80.
“She’s breathing much better now,” the doctor said.
At the next stop, Skid Row, Behforouz met with Rafer Henderson, 63, who is HIV positive, has lost 70 pounds in the last year, suffers from depression and was recently hospitalized with respiratory failure. He told me his struggles, which led to homelessness, began when he developed a drug addiction during a 30-year career in the aerospace industry as a sheet metal polisher.
Behforouz sat next to Henderson on his bed, examined his throat (he has trouble swallowing) and said as we left that she would contact his GP to take notes. Much of what Housing for Health does is sort paperwork, eliminate bureaucracy, coordinate multiple aspects of care, and keep track.
LA County voters deserve a pat on the back for the growth of this model, funded in part by the Measure H quarter-cent sales tax hike approved almost five years ago. Behforouz hopes the flow of funding will be extended beyond the 10-year life of the measure.
She spoke of the “incredible trauma of body and soul that” is visible to all of us. “It’s devastating because we have the technology and the wealth to take care of everyone in this country, but we don’t, and that just keeps killing me.”
It’s not, she said, like we don’t know what works.
https://www.latimes.com/california/story/2022-07-23/lopez-column-stalked-by-death-they-are-gathered-off-the-streets-and-cared-for-army-of-angels Column: Housing for Health aids formerly homeless Angelenos