Here in Boston, the air can be bitter cold in late March, spring often eludes us until the early weeks of May. So, it was still brisk that day when our patient Margaret* left the cramped shelter space she shared with several other women. In her late 60s, at an age when many of us have retired, Margaret was working her shift at a grocery store. Her days were exhausting: the trek she makes back and forth to work from the shelter via the city bus system, standing on her feet throughout her shift, scanning and bagging, and the loneliness and lack of privacy at the shelter each night.
Earlier that week in March, the Governor of Massachusetts had issued a state of emergency: to slow the spread of COVID-19, all non-essential workers were told to stay home and practice social distancing. Restaurants could no longer seat customers, many retail stores shuttered, and offices around the state closed their doors, directing their employees to work when possible from their homes. As an employee at a grocery store, Margaret was considered an essential worker, earning minimal wages. She had found herself on the front lines of the pandemic, exposing herself each day to potentially contracting the virus, at that time, without proper PPE or social distancing measures fully understood.
Early in her shift that morning, Margaret started feeling ill with chills, then came violent shaking, and a fever. For fear of losing wages for the day, she asked her boss if she could lay down and rest for a while in the store office. Ultimately, Margaret realized that she was too sick to continue working her shift. She got back on the city bus and headed back to the shelter. As the day dragged on, the symptoms got worse: a violent cough, followed by a severe headache, and then the fever worsened. Once that happened, the shelter staff became aware and called an ambulance and Margaret was admitted to the hospital and diagnosed with COVID-19. After several days in the hospital, her symptoms somewhat improved and she was discharged to our care at the Barbara McInnis House (BMH) respite program to recover and isolate, freeing up her hospital bed for another, more severely ill COVID-19+ patient.
Weeks before the stay at home order was put in place, our medical leadership had already prepared for the anticipated stress on the hospital system. We knew that many of our patients would have nowhere to go to recover safely, so we converted 52 respite beds into a COVID ward to care for patients who were COVID-19+ and were experiencing homelessness. Our skilled staff of nurses, public health experts and talented clinicians worked to ensure that our patients, who would not have been able to isolate in a home or in shelter, would have a place to safely recover from the virus. By converting an entire floor of BMH into a COVID-19+ recovery unit, we provided a safe haven for patients like Margaret, and it relieved the patient census at our hospital partners. We had seen what had happened in New York City with the lack of available hospital beds for COVID-19+ patients, and our respite team worked with our partners to avoid that grim scenario.
“Our Respite Care team was incredible” says Director of Nursing at BMH, Suzanne Armstrong, NP, “Our staff pulled together and worked hard, with our patients at the forefront of their minds. I never doubted for a second that our patients were the primary focus. We had nurses staying later than their shifts just to ensure that patients were transferred from hospitals smoothly and safely into respite. I feel proud that our staff makes patient safety a priority.”
The COVID-19 pandemic has sliced open and exposed the raw reality of systemic injustice in this country. We have seen that Black and brown Americans, like Margaret, are far more likely to contract COVID-19 than white Americans. As a person experiencing homelessness and living in a shelter, Margaret did not have the choices so many of us have…she had to go to work to her minimum wage job, and ended up risking her health by contracting COVID-19.
Margaret was so grateful for our care, but she told us that she also felt shame and fear: the shame of being COVID-19 positive, the shame of experiencing homelessness and the frightening ramifications of both.The sad reality is: Margaret’s story is not unique. Many of our patients suffer at the hands of systemic injustices like racism, classism, homophobia, economic disparities, sexism and the intersection of all those societal ills.
Dr. Jen Brody, BHCHP physician who cared for Margaret, believes, “Too often our essential workers are seen as disposable. The reality is no one should be considered disposable. No person is! Our patients are resilient people who are made deeply vulnerable by social forces, which creates tremendous barriers to health and thriving. This woman is elderly, she should be retired and taking it easy, but instead she still goes to work each day at a grocery store, in the midst of a pandemic, and returns each night to a cramped shelter. I love our patients and am privileged to be able to provide them the excellent clinical care they deserve. It’s profoundly unfair that by the time they come to us they’ve already overcome so much. “
Your gift to BHCHP this year, can help patients like Margaret. Our dedicated team cared for her with clinical acumen and compassion, and offered her a safe space to recover from COVID-19 with dignity. BHCHP has been a beacon in the community for over 35 years, providing or assuring health care for our patients, who are too often marginalized by society.
“Patients like Margaret show me the wide-range of life stories that people experiencing homelessness have,” says Kathleen Saunders, NP at the Barbara McInnis House, “Everyone has certain images or connotations they associate with homelessness. But the thing that all people experiencing homelessness share is the inability to secure housing. At Boston Health Care for the Homeless, I work to make sure that my patients don’t have to worry about accessing high-quality health care. I make it my mission to make our patients feel seen and appreciated as human beings.”
*patient’s name has been changed.