At Tacoma’s Nativity House shelter, extra hands help the elderly and disabled
Stepping into the day center at Nativity House, where homeless men and women gather for meals, refuge and community, it strikes you — the number of people using canes, walkers, wheelchairs and power chairs.
Homeless seniors make up more than 25 percent of those coming to Nativity House, the day and overnight shelter in Tacoma operated by Catholic Community Services of Western Washington. Many of them, like Michael Northern, struggle with normal activities of daily life.
Northern, a former foundry worker who is disabled, slowly navigates his way through the maze of tables and people in the day center, occasionally bumping into something with his walker. The 54-year-old often trips and falls, the result of a stroke earlier this year that is stealing his vision and an earlier injury that left him with paralysis in a lower leg.
But Northern also has hope for the future. “I don’t want to give up, even if the rest of my life is blind or whatever,” he said. “It’s still life, so you want to still live it to your potential of doing good.”
Part of his hope stems from the support of Grace Kariuki, one of two caregivers assigned to the 167-bed shelter under a two-year pilot program funded by the state Legislature this year. The caregivers help senior and disabled guests with things like picking up a meal tray, using the bathroom or shower, taking their medications, doing their laundry or getting to medical and other appointments.
Most of the people Kariuki meets at Nativity House “feel like they don’t have anything else left,” she said. “I always tell them there’s a lot of hope.”
Transitioning out of homelessness
It was creative thinking and persuasion by CCS that brought Medicaid Personal Care services — usually provided to seniors and people with disabilities in their residences — right inside the shelter in 2017. So far, 61 people have qualified and been assigned caregivers, said Peter Nazzal, director of CCS Long Term Care, which provides home care services to the elderly and disabled in Western Washington.
The pilot program, which began July 1, provides a “bridge” of caregiving to Nativity House guests before they receive Medicaid approval.
“We’re kind of flipping the idea on its head,” Nazzal said. “Rather than these caregivers connected to a certain person, they’re connected to the shelter.” So far, 44 people have been served under the bridge program.
“We started doing this as kind of a humanitarian thing,” Nazzal said. But then something else happened: People in the Medicaid program began transitioning out of homelessness. So far, 26 of 61 people have found housing, he said.
Getting a caregiver who provided some stability in their lives and reconnected them with the community “could have been the final piece that was needed by these folks,” Nazzal said, noting that many of them had been homeless for at least two years.
When they move into housing, “their caregiver goes alongside with them and is still able to provide those services so they can be independent,” said Melissa Moss, CCS’ director of Homeless Adult Services. “It’s been that beautiful safety net where they’re not falling out of the system.”
Since caregiver Kathy Dotson entered his life, Rodney Williams has gotten his confidence back after being homeless for years. Photo: Stephen Brashear
More seniors needing more help
The effort to better serve homeless seniors began when the Nativity House staff noticed changing demographics: More seniors, some in their 80s, were coming through the door, needing more assistance to get by in the shelter environment.
“We were watching them struggle with just daily life things, like getting a [meal] tray, and we would have staff do that for them,” said Moss, who back then was working one-one-one with guests while overseeing the shelter’s mental health team. “Some of them would need help with toileting or showering, which our staff were not equipped to do,” she added.
Some of the seniors were homeless for the first time after losing their housing due to rising costs, Moss said. “Really the frustration is there’s no place for them to go,” she said. “It’s not that they have made bad choices. It’s just the housing market has [risen], their income has not. Where do we send them?”
Seeking a solution to meet these seniors’ daily needs, the shelter staff turned to Nazzal and his team. Nazzal, whose office shares a driveway with the shelter, went next door to check out the situation. “It looked more like a ward in a nursing home than it did a homeless shelter,” Nazzal said, recalling his amazement at how many people had canes, walkers and wheelchairs. “I didn’t have a clear understanding of what it’s like now.”
The answer to the need, Moss said, came by Nazzal thinking “outside the box.”
“Yes, this is not our traditional home setting, but this is their home” for 90 days and sometimes longer, she explained. “Why don’t they deserve the same care that other people are getting out in the community?”
Nazzal said the question he asked the state Department of Social and Health Services was, “‘Could we do personal care services for these folks in the shelter?’ and the answer was, ‘Of course.’”
He credits the agency with also thinking creatively, “by having a social worker hold office hours at the shelter to increase the number of people who would accept services.” DSHS has also streamlined the process — one person receives all referrals from Nativity House and she responds quickly to do the assessments
needed to qualify shelter guests for Medicaid, Moss said.
It can take some convincing for a person to realize they need help and apply for the program, according to Nazzal. Some people are unable to sit through the required interview and financial disclosure process, he said, but they can still receive care through the bridge program.
Rodney Williams is one of those who didn’t sign up for care services right away. “It took a long time to swallow my pride,” the 61-year-old said.
It’s been about five years since Williams has worked, finishing his career at a building maintenance company. He uses a cane due to arthritis in his knees and cramps in his hips that get worse with cold weather. When he became homeless, “I slept on the street, I ‘couch slept’ over at numerous different people’s homes. And from there I came here,” Williams said. “I’ve been for years now.”
“Rodney helps out a lot around here,” Moss said, “and is really always volunteering and giving back, stepping in whenever he can.”
Now Williams has a caregiver through the Medicaid program. “I love it,” he said. “It helps me out quite a bit. It gets me around to places I need to get to, my doctors’ appointments and whatever else I need.”
Since his caregiver entered the picture, Moss has seen
Williams get his confidence back. “She’s pretty on top of him with things and pushes him to levels that really have been encouraging to see,” Moss said. “I think that’s where it’s been a beautiful kind of blessing.”
Treating all with dignity
Providing personal care services to Nativity House guests is part of the philosophy Moss brings as shelter director — treating each person who walks through the door with respect.
“I really want it to be like if my son or daughter walked through these doors, that they were truly treated with love and compassion and dignity as anyone else would be. I really have that motto,” Moss said.
The shelter is a “one-stop shop,” where guests are assigned case managers who help them with things like searching for housing and jobs and getting connected to a primary care physician.
“They’re already knocked down and broken,” Moss said, so having the services they need right in the shelter and providing meaningful daily activities can help “build them back up so that they can get back on their feet again with less frustrations and trauma.”
The caregiving program is another way to help homeless seniors with immediate needs and work to get them back on their feet.
Kariuki, the caregiver, has met people at Nativity House who think they’re never getting out of the shelter system. “Something somewhere went wrong [for them], but that doesn’t mean that is the end of the road,” Kariuki said. “If they get help to get up, they’re going to help themselves.”
And seeing others move into housing with the help of the caregiving program gives them hope that they, too, can transition out of homelessness. “I’m happy to know that we are making a difference in somebody’s life,” Kariuki said.
Nazzal is advocating for the program to expand. “We’re trying to get as many groups doing this as possible,” he said.
In September, a shelter and nonprofit home care agency in Vancouver began offering Medicaid Personal Care services, Nazzal said. By the end of 2019, two CCS shelters in Seattle will offer the program, he said, and another nonprofit home care agency will partner with another Seattle shelter to offer the services.
“That’s my excitement,” Moss said, “is to see other shelters or other facilities starting to do the same kind of thing and realizing this is their home. … They deserve the same kind of services that the 80-year-old woman would get in her apartment.”
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