Caring for the Health Needs of the Homeless IT TAKES A VILLAGE ( and six angelw )

Words by Kim Malakowsky |

Design Lounge

we’re right there with them. Rapport and relationships are real important.”

Whitney Fear arrives at the clinic each morning handling nurse triage duties. Outreach and outpatient nursing case management are a large part of her day. Along with working in the clinic, she visits homeless shelters in an attempt to inform and engage those in need of medical attention. She strives to reach the population that is hiding, unwilling to engage, or don’t have the resources to access primary care.

Nurse practitioner Alicia Hauff speaks about her work as the center’s medical provider. “New patients often require checking lab work, just to see where they’re at right now. Often times it’s a whole complicated history, there can be more than one chronic illness going on but also there’s often some mental illness too or mental plus addiction issues.”

Nearly two decades ago, a tiny clinic began operating in the basement of the Salvation Army in Fargo, North Dakota. It was in response to unfolding events of the ‘80s, a time of deinstitutionalization of the mentally ill and the return of Vietnam veterans. Homelessness was exploding across the nation.

A young Fargo nurse volunteered in a pilot program geared at providing healthcare to those individuals who are hard to serve and hard to engage, who are out on the streets. She applied for and received a grant to fund a healthcare for the homeless program.

Today, on NP Avenue you’ll find a larger clinic, one continuing to serve the homeless population and run by Kim Seeb, a licensed social worker, program director and case manager of Homeless Health. Behind the scenes is a story of compassion, strength, and an uncommon bond of six women and the people they serve.

On a typical morning the lobby begins to fill with those seeking medical care. It’s a walk-in clinic — no appointments are needed. Many have slept outdoors; they smell like campfires, they’re cold, wet, tired and sick. Jill Thorsen knows the drill and handles the patients with great care getting them registered and handing them off to Denise Hansen who handles the intake and rooming of each patient.

“There are days when the lobby is kind of crazy,” says Seeb. “But it’s about meeting the patients where they’re at and making sure they know we’re not looking down on them and

A chronic disease is hard to deal with under normal circumstances. On the street, the job becomes often times overwhelming. Seeb explains, “It’s one of the things we had to learn early on, you just have to be flexible and creative. You can’t give someone who’s sleeping outside a bottle of insulin that needs to be refrigerated and say, ‘Here, take this three times a day.’ It’s a harm reduction kind of approach. What can we do that decreases the harm that happens with someone who is chronically ill?”

Numbers of homeless individuals in our community continue to rise due in part to a lack of affordable housing. Homeless Health serves not only the chronic homeless but also the newly homeless and imminent homeless. Seeb describes, “We see patients who are working or going to school. Something happened and they got behind or had a health crisis, a mental health crisis, or something, and they ended up homeless.” Some of these individuals find a place to sleep at the area shelters; some sleep in their cars, working full- or part-time jobs during the day.

Knowing the impact homelessness has on one’s health, an essential part of the program is working with individuals to find them access to housing. “We do whatever it takes to get someone housed with whatever resources we have. There is only six of us all together, so we rely heavily on community partners for helping and accessing different services,” says Seeb.

Cooper House is one of those community partners. Homeless Health staff member and nurse Bonnie Erickson spends 20 hours a week serving patients in this 42-unit building constructed to provide permanent supportive housing for people coming out of homelessness. Erickson, like Fear, supports the homeless with outpatient nursing case management, a service not typically offered by other clinics.

The relationship, built with time and trust, continues once an individual is housed through the city’s various programs. For the next year the staff continue to work with the individuals. Once they are independent and doing well on their own, a transition to Family HealthCare — a primary care clinic providing a widevariety of medical services with a sliding fee scale — can take place. “We want to help them maintain their health,” says Seeb, “so they don’t end up back in a shelter or on the street. We have a lot of flexibility with the definition of homelessness, or being able to stay with them and continue to work with them.”

“Don’t judge,” concludes the staff, “just do what you can and hope that it’s the hook that will get them to trust you and seek help when they need it.”

The days are filled with challenges. They are filled with rewards as well. A patient leaves the lobby, “Ok, thanks, love ya.” Echoing brightly from the office, “Love you back.”