Advocates are trying to repair a system that can put society's most vulnerable at risk.
By Christina Jewett -- Bee Staff Writer
Published 2:15 am PST Sunday, March 23, 2003
County nurse Vickey Carlson reaches out to Leroy Burchett as he wakes from a nap under a semitrailer. He was awaiting glaucoma surgery. Sacramento Bee/Lezlie Sterling
Gregory Holland took a cigarette break Monday, some time to stare at the blue sky rather than the beams that hold the bunk above him. He was staying at Sacramento's Salvation Army shelter, recovering from surgery after a blood clot lodged in his leg. A shelter manager is on the patio, too, smoking in the sun.
Neither realizes that, for Holland, each drag on the cigarette is like tightening a vise around his veins, increasing the chances that a clot will lodge in the path to his heart.
Holland showed up at the shelter staggering, without a cane to support a swelling knee.
Two county nurses treat patients in Sacramento's half dozen or so shelters. Most shelter employees have little training beyond cleaning a cut; some are barred from distributing aspirin.
Hospital administrators in charge of discharging patients say they face dwindling resources and towering demand for beds. The problem is likely to compound if proposed federal, state and county budget cuts prompt hospitals to lay off staff and the county to close three clinics that serve the poor.
"We're frustrated," said Kevin Bond, director of social services for the Salvation Army. "We're taking care of horrible conditions. It's just not appropriate."
Shelter managers say they depend on Vickey Carlson, one of the county's two homeless care nurses.
On Wednesday, she sat on the pavement on 14th Street, outside the Volunteers of America Shelter. She woke Leroy Burchett, who was sleeping in the shade of a semitrailer. She jotted notes about his case: "staying at the VOA shelter, awaiting glaucoma surgery, has transportation."
She set her business card, which included her cell phone number, on Burchett's coat, which was spread out on the street.
"Don't hesitate to call me if you have problems," she said.
Carlson has a filing cabinet at each of the five shelters she visits weekly. She goes where the patients are: along the Sacramento River, in alleys downtown, near freeways.
When patients show up at shelters in terrible shape, she calls a cab to take them back to hospitals. In December, she called a cab for a man who was dropped off at a shelter with a fresh cast on a leg fractured in eight places and a crumbled prescription slip in his hand.
"He was immobile and in pain, and he had no means to fill the prescriptions," she said.
Carlson arranged for hospital administrators to place Holland at the Salvation Army shelter at 1200 North B St., the only one that allows up to eight patients to occupy beds during the day. She learned he had no cane and scoured her resources for a walker.
"These people can't even lay down on a park bench because they're going to get roused up," she said. "They need to just plain get well."
Seeking to remedy the situation, county Department of Health and Human Services officials in 2000 applied for federal funds to reserve six beds in a detoxification shelter, where a nurse could care for homeless patients. The annual price tag: $150,000. The proposal was denied.
"We need to work together to not make shelters a dumping ground," said Linda Shaw, co-chairwoman of a county and UC Davis Medical Center task force to address health care and homelessness.
"(Hospitals) need to get people out who have no place to go. Hospitals get desperate. It's a bad situation."
She said hospital and county officials came together this year to increase communication about discharge planning. They are seeking a California Endowment planning grant that would enable them to slow the merry-go-round of critical health recurrences among the county's poorest.
The grant would allow officials to fill a hole in the system: the lack of a buffer zone between intensive care units and shelter bunks.
Doctors tend to keep homeless patients longer than others, said Dr. Amerish Bera, medical director of primary care services for Sacramento County.
"It's an unnatural inclination for doctors to release someone into a black hole," Bera said.
It costs an average of about $3,600 per night for a patient to stay overnight in a surgery bed, said Carole Gan, a spokeswoman for UC Davis Medical Center.
Karen Warne, who manages discharge planning at UC Davis Medical Center, said patient stays in general have been growing shorter over the years as the hospital seeks to treat patients more efficiently. "We're always struggling for beds," she said.
Still, she said, all patients are evaluated for admission and discharge on medical merits, regardless of their living situations.
Shaw said the California Endowment grant might help if funding is secured for respite care rooms in the Saybrook Apartments, on 47th Avenue near Highway 99, which are being converted into transitional housing.
The rooms would be a miniature version of a 90-bed respite care house in Boston. There, at a cost of about $300 per night, professional staff cares for and feeds homeless patients, said Sarah Ciambrone, director of the Barbara McGinnis House.
"It's for people too sick to be in shelter, and not ill enough to be in a hospital," Ciambrone said.
And the concept may be spreading. Philip Mangano, a former director of Massachusetts homeless programs, overhauled that state's system with a zero tolerance policy: Jails, hospitals and mental health facilities were ordered to discharge people into a stable setting.
A year ago, President Bush appointed Mangano to head the nation's coordinating council for homelessness. Mangano said studies show that taxpayers spend about the same amount for homeless housing programs as repeat jail and emergency room visits.
"There are moral and humane reasons, but also economic reasons -- that the step out of an institution should be the first step out of homelessness," Mangano said.
Shaw already sees evidence of Mangano's work in her office. She said applications for federal money ask about discharge plans -- a clear sign that money might follow to implement them.
County and national proposals might help Carlson do her work, but during a recent visit she could reel off as many wrenching stories as homeless patients lined up to see her.
"They don't value their own health because no one else values their life," she said. "How do you instill in them it's important enough to hold onto?"
About the Writer
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The Bee's Christina Jewett can be reached at (916) 321-1201 or cjewett@sacbee.com. 
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The Bee's Christina Jewett can be reached at (916) 321-1201 or cjewett@sacbee.com.
Gregory Holland, recovering from surgery for a blood clot, uses a walker to return to his bed at the Salvation Army shelter, which allows up to eight patients to occupy beds during the day. Sacramento Bee/Lezlie Sterling
Vickey Carlson, one of two county nurses who work with the homeless, hands medicine to Donna DeVaney, a homeless grandmother, after evaluating her grandson at St. John's shelter. Carlson sees patients at five shelters and travels to alleys, freeways, rivers -- wherever homeless people go. Sacramento Bee/Lezlie Sterling
Vickey Carlson questions Louis Reitman, homeless for two years, before a medical evaluation at the Volunteers of America shelter. Carlson says the very ill homeless urgently need a place to convalesce. Sacramento Bee/Lezlie Sterling
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Comment: This article may be kind of dated. However, the situation for homeless people in Sacramento is worse than ever, especially under the callous cold-blooded Bush Administration. My dear Friend Nurse VIckey is a blessing for many of the homeless and those living in transitional housing as a true medical spiritual helper. We need more such helpers but she is one of a kind.
~Peter S. Lopez
Email= sacranative@yahoo.com
Email= sacranative@yahoo.com
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