Clifton Jasper has come a long way since December, when he was living on the streets of Los Angeles, all but crippled by multiple ulcers on his legs. For eight years he tended his ulcers by himself on the streets, changing his dressings in bathrooms in public libraries and restaurants — any place he could find running water and soap. Emergency room nurses at Harbor UCLA Hospital helped him here and there, but the ulcers only worsened. Finally the pain became unbearable, he said.
On January 2nd, Jasper was admitted to Harbor UCLA hospital and kept for ten days. When he was deemed stable enough for discharge, he could have been turned back to the streets, like most homeless people. He could have been relegated to caring for his wounds in unsanitary sinks again. Instead, on January 18th, Jasper was discharged to the JWCH Institute’s Recuperative Care Program in Bell. There, he was given a clean bed in a small dormitory with other recuperating homeless men, 24-hour access to registered nurses and weekly check-ups with a physician. His dressings were changed regularly, his medication tracked and made available to him at the appointed times, and he was able to rest.
I met Jasper in August. He was sitting at the edge of his bed at JWCH’s Recuperative Care Center in Los Angeles, at the corner of San Pedro and 6th Street. It was mid-morning when the program’s manager, Dee Saupan, LVN, gave me a tour of the place. Jasper let me check out his small room. His legs were still bandaged up, but he was happy about the progress he was making. And with no family to lean on, he was clearly grateful to be there.
JWCH’s Recuperative Care program is the largest medical respite program for the homeless in Los Angeles County. And the oldest, too. It was started in 1991 when The JWCH Institute’s street outreach team recognized that a portion of Skid Row’s homeless, with large abscesses and other acute problems, were too sick even for a shelter.
So, according to JWCH Institute’s CEO, Al Ballesteros, the nonprofit began renting rooms at the Weingart Center — a 10-story building in the heart of LA’s Skid Row inhabited entirely by organizations and programs that serve the homeless. Today, JWCH’s Recuperative Care program has 23 beds on the second floor of the Weingart Center and 30 more in a newer facility in Bell. That’s 53 recuperative beds altogether. It has contracts with seven private LA County hospitals. Plus, all four County hospitals regularly refer patients who have nowhere to go. The center bills the hospitals $162 for each bed night the patient is in their program; that’s one tenth of what it would cost the average hospital to keep the patient overnight, said JWCH’s Recuperative Care Program’s director, Marcus Hong. Hong said patients discharged to JWCH’s program who stay until they get well have a 73 percent reduction in hospital inpatient stays, and a 32 percent reduction in ER visits. A third of them go into permanent housing, a third into transitional housing and a third are reunited with family, said one of the social workers.
The program basically allows hospitals to discharge the patients when they’re ready to be discharged, and not hold them over for want of alternatives.
The average length of stay for patients at JWCH’s program is 30 days, according to Hong, but some hospitals balk at paying for more than 10 days. Ballesteros says that attitude is penny-wise and pound-foolish.
“How do you put someone out on the streets or in a shelter in ten days?” he asked. In the end, the center ends up keeping patients longer, billing the hospital for as much as 30 days.
A dozen or more studies have established that medical respite saves money for acute care hospitals. A July 2006 study in The Journal of Public Health, for example, compared two groups of homeless people who’d been discharged from an acute care hospital. One group was accepted into a medical respite center on discharge, while members of the other group weren’t accepted into the centers because they were full. After 26 months, the study began keeping track of their hospital visits, and in 12 months, patients who’d been in a medical respite program spent 50% fewer days in the hospital than the ones who were turned away.
At JWCH’s Weingart Center location, some of the rooms are funded by the Housing and Urban Development department, and a handful are kept on hand as transitional housing, for patients who are well enough to leave, but have no place to go yet. There are rules. Alcohol and drugs are not tolerated anywhere in the ten-story building. Patients on oxygen aren’t accepted because of the fire hazard. Sometimes, because patients have had addictions, they need to be convinced to comply with their aftercare, to take care of themselves.
Ironically, the patient dumping scandal of 2006 was what allowed JWCH to double its Recuperative Care program beds. When Los Angeles’ City Attorney charged Kaiser Permanente with elder endangerment, among other charges, for discharging a homeless patient to a shelter (put her in a taxi while still dressed in her hospital gown) Kaiser settled the case. Kaiser paid JWCH Institute $500,000, which the program used to construct a new 30-bed center in Bell. Those 30-beds positioned the program for a demonstration project that launched the same year. Funded by the National Health Foundation, seven private hospitals in LA County collaborated to see if recuperative care could save them money. Though the funding wasn’t renewed after two years, all seven of the hospitals maintain contracts with the program.
While touring the place, I also met a guy named Larry. Larry was loquacious and outgoing and wheeled his chair up to me to praise the program. He’d had three amputation surgeries (on the same leg) in a year, and will have one more soon. The 50-something man was effusive.
“It’s been a blessing. They’ve taken such good care of me. And she’s the nicest one,” he said, nodding his head in Nurse Saupan’s direction.
Larry is about to leave JWCH. Case managers found him a one-bedroom apartment in Valencia, near the Santa Clara River. Like every one of JWCH’s Recuperative Care patients who leave, Larry will be enrolled in The Center for Community Health, a big new health center that’s half a block up from The Weingart Center. It’s a primary care and social service clinic operated through a collaboration between JWCH, The Weingart Association, Los Angeles County, and a half dozen other agencies. That’s where Larry will go for his check-ups and outpatient care. And just to make sure transportation isn’t an obstacle, the Recuperative Care program gives everyone Access cards when they leave, for free bus service.
By Isabelle T. Walker
Photo of Curtis Jasper and Dee Saupan by Isabelle T. Walker.
This article was conceived and produced as a project for the Online Community Building and Health Fellowship, which is administered by The California Endowment Health Journalism Fellowships, a program of USC’s Annenberg School for Communcation & Journalism.
. I’m not supposed to be hsoelems. I shouldn’t be living like this. Last week he was. And so were many young people like him.It had been two years since he lost his job, the best one he said he ever had. Woolridge was the mascot of the Newark Bears — Ruppert — and the clubhouse manager, until he got laid off in 2007 when the baseball team changed ownership. It was a great gig, because the stadium was home, too. He took care of the clubhouse, cleaned it, washed the players’ uniforms, then crashed in an office overnight.When the job was over, so was his place to stay. That’s why I fell off, he said.He bounced from one friend’s house to another, holding down jobs at ShopRite, then Walgreens, but never making enough, he says, to be stable.He knew it was rough out here, but not like this, not to the point of Penn Station.He found himself somewhere by the PATH train, sleeping to stay warm, then heard there would be social service agencies at the Essex County Skating Rink in Branch Brook Park Wednesday. About 50 of the agencies come every year as part of a statewide program to count the hsoelems and connect them to services. The effort takes place in other counties as well, with volunteers looking for the hsoelems by waterfrosnts, bridges, abandoned warehouses and other places they may frequent to stay warm. Results are then turned over to the U.S. Department of Housing and Urban Development.While urban areas bear the brunt of poverty, the suffering has spread to Essex suburbs in ways that leave county officials staggered. Our food stamp program grew by 50 percent, and our Medicaid caseload grew by 31 percent in the last two years, said Bruce Nigro, the county’s director of welfare. In Montclair two years ago, 925 people applied for food stamps. That number has jumped to 1,256. In West Orange, 750 cases increased to 1,371, and Maplewood rose from 347 to 637, Livingston from 85 to 161. We’re seeing numbers we’ve never seen before, Nigro said. These are people who lost their jobs. A state agency tracking the face of the hsoelems sees more and more families in crisis every year. That was the one thing that stood out from the past two years, said Colleen Velez, program manager for the New Jersey Corporation for Supportive Housing. It was the beginning downturn of the economy. The need was evident Wednesday. Crowds of people showed up at the skating rink, lining up as early as 7 a.m., three hours before the doors opened. Kids were in strollers. Toddlers getting restless cried once inside. The playful ones ran around, then slid on the floor, laughing. The young families ate boxed lunches in the cafeteria, talked to representatives from the slew of agencies. They grabbed pamphlets and signed up for services if they were eligible. Soulful music played to make things somewhat festive, to make people feel better.Darnella Smith, 38, was one of them. She’s been in Newark five months, living in transitional housing, having relocated when a storm flooded her home in Florida. Smith wants to work, but that’s going to be hard now. She’s five months pregnant, has three other children and is on assistance. The free haircuts for her boys were a big help.Sitting next to her was Jacqueline Feliciano, 32. She wasn’t hsoelems but said she goes to the food pantries in Newark so she can feed her two young boys when food is low. The face of the hsoelems is getting younger and younger, said Essex County Executive Joseph DiVincenzo. Look at all of the people here. In his county, DiVincenzo said, one out of every five residents is on some form of assistance. It’s disturbing to him. Make that alarming. More and more of these kids need jobs, he said. We need to find jobs for these young people. They want to work. They want help. That could be anyone of our kids. That could happen to anybody. In the early-morning hours Wednesday — midnight to 4 a.m. — volunteers fanned out in Newark to find the hsoelems so they could count them and tell them to come to the skating rink for help. Many of the usual haunts, like the old Essex County Jail, were abandoned. The waterfront was empty except for a loner known only as Fred. No one was under Route 280 by McCarter Highway, either. There were only remnants — clothing, bottles, cardboard, tarps — that let you know somebody had slept there at some point. It was cold, and many had found shelter elsewhere.At Penn Station, a dozen or so people were on the floor in an enclosure by the Market Street bus lane. There was no heat, but it kept the wind out. They slept on newspapers, feet sticking out from underneath blankets, some with cardboard. One pair of small shoes was sandwiched by two larger pairs of feet: This is a family.Upstairs by the PATH train, several more people found refuge in a vestibule. When the train pulled in around 3 a.m., they got on to ride all night long.The final tally of hsoelems won’t be known for several days, but officials said 733 people came to the rink for help. Some had their eyes checked, others a haircut or nails done. Little things to ease the pain. They just needed something extra, maybe a hat, a coat for their kid, information on where to get food when the shelves get empty at the end of the month.However you slice it — urban vs. suburbs — people are hurting. On cold nights, they are at Penn Station and shelters.It’s enough to depress even the toughest of us.But then there was Woolridge. He has been on his own since 19, when he had to leave home. Time for him to be a man, he said. He’s always worked. Even now, with no place to stay, he tended one of the food concession stands at Newark’s Prudential Center.He takes the money he earns to care for his 1-year-old daughter, whom he sees as much as possible. That makes him proud. He said he prays to keep his head on straight and attends New Hope Baptist Church when he can on Sundays. He knows he should tell church members about his problems but feels embarrassed. It’s not supposed to be like this.When he made his way to the skating rink, Woolridge bumped into a familiar face from a Bears game. It was DiVincenzo. Woolridge reminded the county executive that they shook hands years ago, when he was Ruppert. DiVincenzo remembered and offered him help so he wouldn’t have to go back to Penn Station.Woolridge accepted, but changed his mind on the way to the shelter on Fulton Street. He was able to camp out with a friend instead.For that night.Then, on Friday, for some reason he can’t explain, Woolridge walked into the general manager’s office at Bears & Eagles Riverfront Stadium.He told them who he was, that he had once been Ruppert the Bear.Well, they said, as it turned out, they needed a Ruppert for the new season. They hired him on the spot.Woolridge starts March 6, making his Ruppert comeback appearance at the Nutley Irish Parade. I’m just trying to get back on my feet, he said. I’m going to see what happens next and go from there.