HomeHEALTHFor the homeless, care homes provide a safe place to die with...

For the homeless, care homes provide a safe place to die with dignity

Jan. 10, 2023 — Tashi Taliaferro doesn’t want anyone to die alone.

Having worked as a nurse for more than 30 years — 12 of them as a hospice nurse — Taliaferro has always felt comfortable around the sick and the dying.

What troubled him was the number of his patients who died without the comfort of family or friends.

“We see people who are in their 80s or 90s without a family. We see veterans and the homeless and the homeless,” says Taliaferro, assistant director of nursing at Advanced Nursing + Home Support, a home health care company in Rockville, MD. have forgotten the underworld.” “We’ve been there with people who had none, and that goes straight to my heart.”

Taliaferro is in the process of opening a residential home for the homeless and chronically underserved in his community of Montgomery County, MD, just outside Washington, DC, which is one of the highest. The rate of residents living in poverty in the country, every night, more than 4,410 people are homeless in the nation’s capital,

Taliaferro says, “No one should die alone, unless that’s his choice.” “I think anyone, no matter how old or young or rich or poor or whatever their background, deserves complete honesty, grace, compassion and love.”

Growing need for end-of-life homes

As the baby boom generation ages, the number of family caregivers will become insufficient for the task of providing care. AARP Policy Institute estimates that by 2030, there will be four potential family carers available for every person over the age of 80. This is compared to a ratio of 7 to 1 in 2010. By 2050, that number will drop to 3 to 1.

Of course, the population of people without homes is also aging. A 2019 report The University of Pennsylvania projects that the number of people 65 and older experiencing homelessness in the United States will nearly triple over the next 7 years, from 40,000 in 2017 to 106,000 by 2030.

The premature aging of homeless Americans is a result of chronic stress associated with living in shelters, living on the streets, and couch surfing. This phenomenon, known as “weathering,” is an area of ​​particular interest to Rebecca Brown, MD, MPH, a geriatrician and assistant professor of medicine at the University of Pennsylvania in Philadelphia.

Brown’s work found that people 50 and older who experienced homelessness had similar or higher rates of geriatric conditions, cognitive impairment, urinary incontinence, frailty, and difficulty performing basic daily activities such as bathing and dressing. 80, compared to those in the general population.

“They get these aging-related conditions when they’re younger, and then, not surprisingly, they also die earlier,” says Brown.

According to Travis Baggett, MD, director of research for Boston Health Care’s For the Homeless Program, many people with a terminal illness such as cancer will continue to receive their care in homeless shelters for as long as they can.

“But once they can’t get out of bed on their own or bathe themselves or need oxygen, which most shelters don’t allow, they can’t stay there anymore,” Baggett said. it is said.

These people may end up cycling between hospitals or nursing homes, where they receive medical care until they die.

Taliaferro is working with Emily Kevey, a professional photographer and end-of-life doula. Like a birth doula, KVs provide psychological, emotional, and physical support to people who are dying and their families. The pair bonded after Taliaferro coordinated care for KV’s dying loved one through her job, finding that they shared a similar desire to help people in their final stages of life.

Taliaferro told KV about his idea for a residential home that would empower underserved and formerly homeless people to die with dignity, and they eventually helped Good Hearts, a non-profit organization, to raise funds for their venture. Foundation launched.

They are still in the early stages of finding a potential donor for a suitable home for the operation, as well as other sources of funding such as grants to set up and run the home.

For now, how the house will be licensed or permitted is unclear. Taliaferro and Cavey are also working out what kind of license they’ll need to operate as a residential home; County officials in Maryland first thought the pair would need a hospice provider license. But the home itself will not provide medical services. Residents would be able to visit outside health care providers to provide services, but there would be no financial relationship between the residential facility and those companies.

They already have a name for the first house: Maddie House, after Taliaferro’s mother, who died in a car accident when Taliaferro was 2 years old. They are expected to open in 2023.

The Grace House: a model care home for the homeless

Taliaferro got her spark for Maddie House after learning about the Omega Home Network, a membership of 40 residential homes and other developments that all serve the same purpose of providing a loving environment for people who would otherwise be living their final lives. Lived alone for days.

Grace House, a care home in Akron, OH and part of a network, opened in September 2022 for the chronically ill.

Funded by grants and donations, the facility has three requirements for residents: they must be enrolled in a hospice program through Medicare, Medicaid or a private insurer; They must have limited financial resources; And they may not have anyone who could otherwise house them and take care of them. All services are free for residents.

Holly Klein, a registered nurse and founder of Grace House, regularly cared for homeless patients during her 14 years as an in-home hospice nurse in Akron.

“I use the term ‘home’ loosely because it was really wherever the patient lived,” she says. “I met people under a bridge, in motel rooms, in homeless shelters, and in living conditions that were not dignified. It was a burden to see people die alone in those circumstances, and I began to ask the question Said, ‘Isn’t there anything else we should be doing?'”

Hospice providers – who do not have financial ties to Grace House – make regular visits to individual residents such as if residents have their own private homes, to manage clinical care, while home staff Assist residents 24/7 with cooking, cleaning. personal care, and drug administration.

“We think of ourselves as a surrogate family,” says Klein. “And anything that a hospice program can teach a family to do in their own home, they can teach our staff to do, such as simple dressing changes and medication education.”

Since opening, 16 residents with terminal illnesses such as heart disease and kidney disease have come to live and die within the four walls of Grace House.

Five residents experienced homelessness before they arrived, and many came from homes “that were literally falling over on them or didn’t have running water, electricity or heat,” Klein says.

Grace House residents who lived on their own for years may enter the withdrawn and discreet facility. But many strike up friendships with each other, staff and volunteers – and even reconnect with loved ones laid off in the last days and weeks of their lives.

“We provide an environment where they feel safe and secure, which enables them to drop some of those walls and old habits to reconnect with people,” Klein says. “It’s been amazing to watch.”

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