A Guest Reflection by Courtney Pladsden, FNP, who is the nurse at Charlie's Place.
A wise professor one said that 'community health is the act of moving a mountain stone by stone '. Homeless outreach is often the opposite of conventional healthcare. It is a long slow process of developing relationships and sometimes never being able to measure outcomes or benefits of the care provided. In the case of 'Jared Price', we had the opportunity to see how not only essential outreach care is but also how powerful it can be. Mr. Price had been homeless for close to 20 years and went through periods of his life struggling with mental illness and substance abuse. During one of his many emergency room visits in the summer of 2012 he was informed that the chronic cough he had been experiencing was in fact neck cancer. After months of denial and relying on alcohol instead of seeking medical care, on a Tuesday morning at Charlie's Place he sat across the desk from me and said "alright, I'm ready to face this".
Mr. Price had been partaking in the breakfast program at Charlie's Place for years, but this was the first day he signed his name on the list to be seen by the Nurse Practitioner. Through this outreach encounter we were able to be there for Mr. Price when he was ready. This simple act got the ball rolling and we were able to connect Mr. Price with case management, a housing coordinator, oncology care, and he was started on chemotherapy and radiation. After months of therapy Mr. Price's cancer continued to spread rapidly and did not respond well to treatment. At that time, his team of healthcare providers and him decided to initiate palliative care. While housed in an apartment, we were able to coordinate visiting hospice nursing, which allowed Mr. Price to maintain his independence, dignity, and do the things he enjoyed such as playing chess in the park and going for long walks. Once he was no longer able to live independently he was transferred to a respite home for the homeless where he lived out the last few months of his life surrounded by a supportive and caring staff. He passed away peacefully, comfortably, and with dignity.
Homeless people experience a disproportionate amount of mental illness, chronic illness, and substance abuse compared to housed persons and homeless outreach programs such as Charlie's Place decreases many of the significant barriers to care. In Mr. Price's case, we were able to meet him where he was at a time when he was most vulnerable and intervene in a meaningful way. It is not uncommon for chronically ill homeless people to die on the street but this is not how Mr. Price's life ended thanks to programs like Charlie's Place.