By Jacqueline Carson
Jacqueline Carson is a senior pre-medical student at Washington and Lee majoring in Biology and Economics and minoring in Poverty and Human Capability. She is serves as the President of the Nabors Service League. She is searching for poverty-related non-profit jobs for after graduation in anticipation of attending medical school the following year.
Last summer, I was placed in the new Shepherd internship location of Phoenix Health Care for the Homeless in Louisville, Kentucky. I had an incredible experience working for the organization – it taught me so much about the city and about poverty in the area.
Carson pictured at an abandoned homeless camp in Louisville in 2015.
The Louisville homeless population is massive for a small city, but the social services are excellent. Because the services are so bountiful, the city attracts the homeless from all over the mid-west. There are five different city funded shelters and numerous food banks. Each of the organizations that accept funding from the Department of Housing and Urban Development (HUD) are required to keep records on all the entries and exits of the homeless that use their facilities. This establishes a connectedness between the agencies and providers to better grasp the clients’ history. The team I worked on, the Common Assessment Team, was run through Phoenix Health; however, its job is to coordinate the homeless from all the HUD agencies and try to get them into available housing.
As of December 2014, there were 7,348 people staying in the shelters and approximately 200 people staying on the streets, a staggering number for a city of just over 610,000. The history of the dramatic increase in Louisville homelessness dates to the 1980s when the downtown began a beatification effort. Most of the public housing projects were torn down and replaced by mixed income housing. No public housing projects were built to replace the ones that had been torn down and only a handful of housing vouchers were given to the former residents, displacing most of them to the streets.
Jacqueline Carson, Washington and Lee, 2016
Many wonderful things are happening in Louisville related to ending homelessness. For example, the city has adopted a Housing First model, a program where there are no barriers to receiving housing. This year, the federal government has given homeless focused agencies thousands of dollars in order to end veteran homelessness in 2015 and to end chronic homelessness in 2016. When I returned to school in August, the city was on track with over half of its homeless vets in supportive housing. The collaboration between the non-profit initiatives and government policy is proving to be a critical aspect in eradicating Louisville homelessness. On the surface, there is astounding of communication between all the shelters and different HUD agencies – something that I had never seen before in a city, but certainly works well for Louisville. Many churches and other religious organizations provide food and shelter and coordinate functions with the HUD agencies. Additionally, healthcare options for the homeless are excellent – Phoenix health clinic serves only homeless or formerly homeless clients and there are also medical outreach teams. Kentucky is a Medicaid expansion state, which allows for the extremely poor to get the coverage they desperately need. With the recent political transition in the state, the Medicaid expansion is at risk of being cut. This would put healthcare for the homeless in danger and make it even more difficult for them to rise out of poverty.
There are also several areas in which Louisville needs to improve. I discovered these needs as I talked to homeless persons and worked with the organizations regularly. First, the shelters are not perceived by the homeless as safe and clean. Many of the homeless would rather stay on the streets than in the shelters because they fear their belongings will be stolen, they will be beaten, or they will be living in spaces that are dirty and overcrowded. The shelters could be a way to propel the homeless out of their destitute poverty, but it does not seem as though they are reaching their fullest potential. In addition, the services for homeless families are limited and there is far greater need than space available. There is one family shelter, and it has space for only 24 families. I met and interviewed far more than 24 homeless families creating a long wait list for family shelter.
As a member of the Common Assessment team, I used the Vulnerability Index & Service Prioritization Decision Assistance Tool (VI-SPDAT) to assess the homeless’ vulnerability. Their score on the SPDAT put them on a waitlist for housing. The theory is the highest scoring people get the housing first, though this does not always occur. This 50 question survey asks about 4 topics: history of homelessness, socialization and daily functionings, risks, and wellness. While the SPDAT offers a fair way of assessing vulnerability and assigning housing to the people who need it the most, there are many problems, though the issues are outside the scope of this essay. The larger issue at hand is there are too many homeless for the limited housing space. There is not nearly enough affordable housing in Louisville. Over 12,000 households in Louisville need affordable housing, yet the government has only agreed to building 750 new units.
Before my internship, I had learned about poverty only through studies, but over two months, I learned firsthand about the homelessness in Louisville. Countless times, I was asked “What is the homeless archetype?” I answered, “There is no one answer – everyone’s story is unique.” However, some key patterns did emerge: many of the Louisville homeless experience mental illness and some sort of substance abuse. Most homeless women are victims of domestic violence and have had issues with corrupt landlords. One of the biggest takeaways was that the homeless and underserved crave someone to listen to them and treat them “normally,” without judgment. I spent hundreds of hours surveying and speaking with homeless persons, and when I took the time to sit down and get to know them instead of treating them like they were untouchable, they opened up to me, sharing small details of their stories. I even witnessed gratitude and a large sense of relief. There is much burn out among providers who care for the underserved, so when the underserved encounter a new person that will hear them out, they latch on to us.
Working with the homeless population in this medical and social context made me realize that effective care for these underserved persons could yield so many positive externalities for both them and society. Too few doctors want to work with the underserved because the practice is not as glamorous and less lucrative. The irony is that these people need healthcare the most and can benefit from it the greatest amount. Through my work, I learned I could really make a difference for someone in grave need, even if it is just listening to their stories. Consequently, my Shepherd Internship affirmed my desire to work with the underserved population. The work is emotionally taxing but also enormously satisfying because of what is possible to achieve.
The single most emotional and long lasting experience I had was with a veteran named “John.” My boss told us about John because someone emailed saying that “John” was truly in need of help. My partner, “Alex,” and I went out to look for “John.” We found him on a Thursday morning on one of the main streets of Louisville. He was easily identifiable because he was in a wheelchair sitting outside of an abortion clinic trying to stop women from going to their appointments. When “Alex” and I arrived, we immediately recognized why “John” needed help. He looked gaunt and ill. He was still in a hospital gown and wore his intake bracelet from a visit two weeks prior. He looked as if he hadn’t showered in months and his mobility was limited because of the wheelchair. He told us that he hated staying in shelters because they were so disgusting, so he slept outside instead. “Alex” administered John’s SPDAT. He scored a 15, almost the highest we had seen. “John” was extremely vulnerable. While “John” was completing his SPDAT with Alex, I administered a SPDAT for an intoxicated man who was threatening to beat up and kill “John.” “Alex” and I broke up the fight and helped “John” get away. This was just another example of “John’s” vulnerability. “Alex” and I concluded that there was no way that “John” would make it through another winter on the streets. We immediately told our boss about “John,” and because he was a veteran, we had the resources to house him. He needed only an intake with a veteran drug and alcohol counselor to be eligible. We set an appointment to meet with him again on Tuesday morning. Alex and I were ecstatic that we were going to help “John” so quickly. When I came to work on Monday morning, my boss let me know that “John” had passed away over the weekend. Apparently, his heart had given out. At that moment, I learned how critical it is to take action in a timely manner because everything can change in an instant. Effective care requires pro-active care. We won’t succeed in every instance, but we can do better, and I plan on being a part of that effort.