Thirty years ago, the Union Rescue Mission in downtown L.A. contacted the UCLA School of Nursing with an intriguing request: Would the school be interested in providing nursing services to homeless adults and children staying at the mission?
Back then, very little was known about the homeless population encamped in the gritty neighborhood of shabby buildings and sidewalks they regarded as “home.” What was a mere 15 miles away might just as well have been a continent away when it came to the distance that separated West Los Angeles from downtown Skid Row. Few health care providers knew how to reach or even treat this forgotten sliver of humanity that remained out of sight and out of mind as L.A. expanded around them.
“At that time, there was little data on the homeless,” recalled Ada Lindsey, who was dean of the School of Nursing when the request was made. “Nobody really knew whether they would come to any clinics for healthcare or whether they would come back for follow-up visits. Nobody even knew much about what kinds of health problems they had.”
But the prospect of reaching out to this underserved transient population and learning from these experiences generated excitement at the school. Soon they realized that there was a need for more comprehensive health services. Could a nurse-managed clinic provide quality primary health care to the homeless and indigent? Would such a clinic be accepted? Could the nursing staff win their trust?
Today, the UCLA Nursing Health Clinic at the Union Rescue Mission has become a national model for its delivery of health care to the poor and homeless. Celebrating its 30th anniversary this month, it is one of the oldest and largest clinics of its kind in the country. And it is also the only shelter-based health clinic in the city that provides health care, not just for homeless men, but women and children as well.
“It means a great deal to me,” said one homeless man staying at the shelter. “People who are homeless — that are down-and-out on their luck, you know — they have medical facilities available to them that help them out.
“It means a great deal,” he reiterated.
Since its founding, the clinic, which manages both acute and chronic illnesses, has provided care in more than 250,000 patient visits. Last year alone, its small staff of six provided comprehensive medical services to more than 2,500 people.
“Health care is an essential part of this mission,” said Reverend Andy Bales, chief executive officer of the Union Rescue Mission. “While it is important to get people off the street and give them shelter and food, many of our guests have a lot of medical complications due to their time on the streets. And these issues, if not addressed, can hold them back from allowing them to move out of homelessness. The care provided by the clinic over the past 30 years has really made a difference in people’s lives.”
Lessons from Skid Row
The men, women and children struggling to survive on the streets often face more complex medical issues and chronic diseases such as diabetes or high blood pressure.
“Simple things become complex and out of control because these individuals don’t access care until it becomes urgent,” said Courtney Lyder, dean of the UCLA School of Nursing. “When you don’t know where you will get your next meal or where will you sleep each night, it’s hard to think about taking care of your health.”
“When an individual comes to the clinic for the first time, it is usually because their chronic condition has become an emergent or urgent situation and reflects years of inadequate medical care,” said Dr. Mary Marfisee, medical director for the clinic. “They may have run out of their medications, or their blood sugar may be sky-high because they’ve lost their insulin and don’t have funds to get any more. They might have spent all night waiting to be seen in a hospital emergency room, only never to be seen.
“So many of these individuals are suffering from what are known as the ‘illnesses of poverty,’” continued Marfisee. “These diseases are preventable or treatable, but they are ignored until they reach the end stage — diabetes that has become renal disease, foot and limb problems from standing all day or wearing ill-fitting shoes.”
Some of the conditions seen at the clinic, especially involving children, are heartbreaking, she said, such as bad dental care that turns into meningitis. With an increase in the number of homeless women and children being seen at the clinic over the past few years, clinicians are also finding that many of the mothers have very poor life skills — and low self-esteem.
Other times, the clinicians encounter illnesses that most medical staff only read about in textbooks. One man, for example, came in because he was not feeling well and suffering seizures. It turned out to be tetanus, a condition rarely seen because of the broad availability of the tetanus vaccine.
Thirty years young and changing
As the needs and population have changed, so have the services provided by the clinic.
In 2011, for example, the School of Nursing received a grant to provide after-hours pediatric nursing care at the clinic. And that has been a boon to families when their children suddenly become ill at night.
“I’m available at night for families that need to be seen for anything,” said Hannah Bampton, a nurse practitioner who spends an evening a week on the women and children’s floor at the mission. “By doing that, we’ve decreased the number of unnecessary urgent-care visits. The child doesn’t need to go to an ER because I’m going to help him here.”
The clinic has also become a valuable teaching environment where nursing and medical students can hone their skills because the small clinic counts on their help to take a patient’s history, do a physical exam and draw blood, among other duties. For many students, it may be their first experience with treating the poor and underserved. Student nurses also learn to work as a team with medical students from UCLA and Charles R. Drew University of Medicine, resulting in better care for patients.
Earlier this year, staff played a major role in fighting a serious outbreak of tuberculosis in Skid Row by testing and educating the homeless about the disease that can be easily spread in close living conditions.
The treatment the homeless receive gives them hope for a better, healthier life and puts them on a path that may lead them out of Skid Row, clinic organizers said.
“The key to the success of the clinic over the past 30 years is the holistic approach that the clinicians take to treating each patient,” said Lyder. “The clinic takes people who have been marginalized in the healthcare system and provides them with a total well-being approach to putting their lives back together.”