Dr Heidi Behforouz had just encountered a critically ill patient in her apartment – a 58-year-old man who was hospitalized four times in six weeks – and now she was in the lobby of the building.
Through the window, the dump lives up to its name. Three men were sprawled on the sidewalk, and Behforouz looked down to see if any guy in particular distress might need immediate help.
“It never ceases to amaze me,” said Behforouz, medical director of a vital Los Angeles County program called Housing for Health. She did similar work in Boston before arriving in Los Angeles in 2015, and she was immediately struck by what she saw on the streets.
“It was horrible, to be honest with you. The scale of the devastation is so much greater here than it was in Boston,” Behforouz said. “People here that I care for are dying at a much younger age.”
Its aim is not just to help them survive, but to thrive, and also to provide street medicine to those who are not yet housed. It’s tough, labor-intensive work involving an army of front-line workers in dozens of public and nonprofit agencies.
About 20,000 people receive this care from Housing for Health, but thousands of people who are currently homeless could use the same comprehensive services from this agency and others that provide it, if only enough resources were available.
We have seen them all there. The sick, the confused, the addicts – products of poverty, trauma, unaffordable housing and an often uncoordinated silo system of care. It’s a disaster that’s hard to fathom in a state that bills itself as the world’s fifth-largest economy and home to world-renowned teaching hospitals.
Last week I wrote about Sean Sauceda, who is thriving in permanent supportive housing after several years of help from Housing for Health, which has been running for a decade. Since then, I have accompanied the Behforouz teams to the homes of patients who were previously homeless and who suffered from serious health problems. Preventing costly hospital runs, return to homelessness and death are the goals.
Elsa Harmon, a Housing for Health registered nurse, arrived mid-morning at the Gardena building from 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 treatment for lung cancer, was vomiting and not ready to meet strangers. He asked if Harmon could come back another day.
It gave me the chance to know Harmon, who grew up in Ecuador. We sat in the community room in Miguel’s building and she told me she was a computer engineer until a middle-aged career change was inspired by her daughter, who worked as a nurse and shared stories of his difficult but rewarding work.
“Usually children 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. leave – while working full time. Eight years ago, she became a registered nurse.
“My patients are my passion, and helping people like Miguel is amazing,” she said, adding that our perception of who is homeless, and why, can change with closer inspection. “The color of your blood, my blood and everyone else’s blood is the same. You must treat your patients with honesty and dignity. … You can’t promise them they’ll live forever, but you can promise them they’ll be well cared for.
On the same day, Harmon announced herself at the South LA apartment of Perla Fuentes, who fled Honduran street crime with her two grandchildren after her daughter was killed and her home was destroyed in a fire. . Fuentes said she and the children were stopped and separated at the border, then reunited and temporarily moved to 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, broke out. She lost her job and couldn’t afford the room, but said she and the children continued to sleep there, slipping in and out when the landlord was away .
She came to the attention of Housing for Health after several hospital stays, and the family now live in an upstairs unit in the backyard of a house.
“Come in,” Fuentes said as we arrived. “My house is your house.”
Fuentes sat in a recliner with a blanket over the lower half of her body. She wore, despite the circumstances, a broad smile that made me think that the prognosis was good, but I was wrong. Harmon explained that the cancer has spread, chemotherapy and radiation treatments have been halted, and Perla’s mother is visiting on a humanitarian visa to help.
The grandchildren, 8 and 10, played the violin in another room and Fuentes’ mother prepared a lunch of fruit salad for all of us. Fuentes insisted that we eat and relax while she and Harmon continued, holding hands like they were longtime friends.
“I trust in God,” Fuentes said of his good mood. “I’m fine.”
“Obviously she’s scared like any human being,” Harmon said, but she found strength in faith. “With less than that, anyone would be on the floor. … I can teach my patients about drugs, but they teach me about life.
Harmon reviewed Fuentes’ latest symptoms and rummaged through a satchel of pill boxes, reminding him of dosages and upcoming medical 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 his nurses, Jonah Malana — along with Housing Works case manager Jasmine Salas — met me at the home of a patient named Micaela Duarte, who lives with her son. In his late 50s, Duarte suffered from multiple advanced heart and lung diseases, as well as diabetes and hypertension.
“Sit down,” Duarte offered with a warm welcome. She sat down at her kitchen table and showed me a chair. Wheezing and choking, she told her visitors that family members were visiting.
“I feel blessed,” she said.
The doctor, nurse, and case manager engaged Duarte with the same elegant bedside manner I had seen Harmon use with his patient. Duarte seemed relaxed and reassured in their presence, but Behforouz and Malana found his blood oxygen level to be close to 70, more than 20 points too low.
Duarte strapped herself to an oxygen tank while the doctor and nurse noticed Duarte hadn’t used her new BiPap machine, which pushes pressurized air into the lungs through a mask. Behforouz noted how confusing it can be for patients to master and become comfortable with such equipment, and she and Malana set out to train Duarte.
It took even the pros a while to make the connections and fit the breathing mask comfortably on Duarte’s face, but over the course of an hour-long visit, the patient’s blood oxygen level reached the 80 years.
“She is breathing much better now,” the doctor said.
At the next stop, at the dump, Behforouz met Rafer Henderson, 63, who is HIV-positive, lost 70 pounds last year, suffers from depression and was recently hospitalized with respiratory failure. He told me his issues, which led to homelessness, began when he developed a drug addiction during a 30-year career in aerospace as a sheet metal polisher.
Behforouz sat next to Henderson on his bed, checked his throat (he has trouble swallowing) and said as he left that she would contact his primary care physician to share notes. A big part of what Housing for Health does is sort through paperwork, reduce bureaucracy, coordinate multiple aspects of care, and stay on top of everything.
LA County voters deserve a pat on the back for the growth of this model, which is partly funded by the quarter-cent Measure H sales tax increase approved nearly five years ago. Behforouz hopes the flow of funding will be extended beyond the 10-year term 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 that’s not the case, and that’s what kills me over and over again.”
It’s not, she says, like we don’t know what works.