Health and homelessness in Seattle

This and the following four articles have been produced as part of a collaboration between the Seattle Times and seven neighborhood news websites highlighting issues facing homeless families living the the Seattle area.

To read more, visit the paper’s Invisible Families project website, where you can find links to the Seattle Times series and to the neighborhood news sites stories.

___________________

When her daughter fell on hard times, Cynthia Nice, a single grandmother, took in four of her grandchildren, adopting three.

Although Nice, 53, had a job at the time as a cashier at Sam’s Club, making ends meet was difficult. “I was making O.K. money, $12 an hour, but, still, being single and taking care of four kids is hard,” Nice says.

Cynthia Nice and her grandson Dovantae

Eventually, paying the rent on a two-bedroom apartment in Renton, for groceries to feed herself and her four grandchildren, and to cover their daycare got to be too much, Nice says. “I was constantly running around, robbing Peter to pay Paul. It was one thing after another. I was overwhelmed.”

So Nice left her job to take care of the children, giving up the Renton apartment and moving in with her daughter, who had a two-room apartment near Northgate, which she shared with her two daughters.

But soon it became clear that living with her daughter and now six children in two-bedroom unit was impossible. “We were all getting on each other’s nerves,” she says.

Nice and her grandchildren were about to move into her van, when a relative suggested she contact the YWCA to help.

She made the call.

Cynthia Nice's grandson Larry

Nice and her grandchildren, Denetriah 8, Alexis 7, Larry 6 and Dovantae 3, were quickly provided temporary shelter in a motel and in a week were placed in a third-floor, three-bedroom unit in the YWCA’s Fir Street shelter near Downtown just off Boren and Yesler.

They were also enrolled in the nearby clinics. Nice going for care at the Carolyn Downs Family Medical Center, and the children to the Odessa Brown Children’s Clinic.

Nice, it turned out, had dangerously high blood pressure. “They were worried: I was so high they thought I might have a heart attack,” Nice says. The Larry and Dovantae had ringworm. Larry also needed treatment for asthma

The story of how Cynthia Nice and her grandchildren became homeless in Seattle is not unusual.

Nor are the health problems: Skin conditions, like ringworm and scabies, for example, and asthma are among the most common problems affecting homeless children.

And untreated chronic conditions, like Cynthia Nice’s hypertension, are increasingly common among the older homeless adults.

Families make more than half of King County’s homeless

While we tend to think of the homeless as single men living on the street—because those are the homeless we see—55 percent of the homeless in King County are, in fact, families with children.

And while we tend to think of mental health problems, chemical dependency and alcohol abuse as leading problems among the homeless, and they are, homeless children often face additional challenges, including high rates of asthma, untreated skin conditions, and developmental problems due to prematurity and low-weight births.

______________________

Washington State Child Homelessness

More than 24,000 Washington children will be homeless each year.

Washington ranks 39th in the nation in the number of homeless children and 35th in the percentage children who are homeless.

Of the 242,000 children living in poverty in Washington, one out of ten is homeless.

SOURCE: America’s Youngest Outcasts by the Campaign to End Child Homelessness

______________________

Overall, on any given day, about 8,200 people in King County are homeless, and an estimated 24,000 King County Residents will spend part of the year without a home, according the United Way King County.

Homeless families, however, are often invisible. Many, after losing their housing, live “doubled-up” in the homes of friends and relatives, sleeping on spare beds, couches or the floor.  Others live in cars and vans tucked away out-of-sight on side streets, parks and under bridges

We don’t think of families when we think of the homeless, says Susie Winston, director of Counseling Services at Sound Mental Health. [See: Project Homestead: 'Housing first' for homeless families], is because the single moms, who usually head up most of these families, are very good at hiding the fact that they and their children are homeless.

Why? Because they’re afraid that Child Protective Services will take their children away, Winston says, so they’ll enroll them in school, registering them under an old address, pick them up promptly after class, and never let school officials know, says Winston. “They don’t want to lose their children.”

Then they may go off with their children to spend the night in a car or van or on the couch in a friend’s apartment, she says.

From America's Youngest Outcasts

SOURCE: America’s Youngest Outcasts by the Campaign to End Child Homelessness

Health & Homelessness

King County’s Health Care for the Homeless Network, which collaborates with 12 local agencies that provide care and health services to the homeless, recently issued its 2009 annual report of the state of the health of the county’s homeless.

The report finds that King County’s homeless population, like the rest of the U.S. Population, is aging, with the percentage of those receiving care through the network over age 40 rising 23 percent over the past 5 years.

Today, the average age of men getting care through King County’s Network is now 46 years and of women, 40.

____________________

Deaths among the homeless

Between 2004 and 2009, 526 homeless died in King County. 85 percent were men. The most common cause was acute intoxication, accounting for one-in-three deaths, but most deaths, 40 percent, were due to natural causes or accidents, such as being struck by a car or train or being killed by a fire in a temporary. Exposure accounted for 15 percent of all deaths. The average age of death was 48 years.

SOURCE: Health Care for the Homeless Network 2009 Annual Report

____________________

Skin conditions due to exposure, infections, trauma, bed bugs, lice and scabies and skin infections are the most common health problems.

A large percentage has mental health conditions including from depression, bipolar disorders and schizophrenia. Chemical and alcohol dependency are common.

Overall, mental health and/or chemical dependency affect half of the King County homeless population.

But as this homeless population ages, chronic diseases that accompany aging become a growing concern, the report says, including diabetes, cardiovascular disease, such as high blood pressure, heart failure and stroke, and respiratory diseases, such as emphysema.

Just like everyone, the homeless grow more frail as they age, the report notes.

Asthma is a problem among both homeless adults and children. National studies have found that homeless children are two times more likely to have asthma, most likely due to exposure to such triggers as household dust, air pollution and respiratory infections.

Community Health Nurse Bernie Creaven, the Community Health Nurse Program Coordinator at the Carolyn Downs Family Medical Center, provides care at the YWCA’s Fir Street shelter. She says that both the parents and the children come to the shelter with unattended medical and psychological needs.

____________________

Homeless Family Health

Homeless families are more than twice as likely as middle-income families (18% vs. 7%) to report that their children have moderate to severe problems such as asthma, dental problems, and emotional difficulties.

SOURCE: America’s Youngest Outcasts by the Campaign to End Child Homelessness

_____________________

Common problems among the homeless children Creaven sees include: asthma; ear, urinary tract and respiratory infections; and skin conditions, such as ringworm, scabies and eczema.

But many children also have tougher to treat problems, she says, such as developmental delays, learning disorders and attention deficit disorder as well as mental health issues, including post-traumatic stress disorder.

Being homeless itself can be traumatic, but about a third of the residents of the Fir Street Shelter are from East Africa, most from Ethiopia or Eritrea, and some are refugees who have been victims of violence from the conflicts in those countries.

Many of these refugees bear psychological scars from these experiences, Creaven says, but even those who came to this county voluntarily find themselves unable to find jobs that can pay the rent and end up homeless. “They are often homesick and depressed, “ she says.

In many cases, the parents are well educated, some have a profession, but difficulties with English make getting work extremely difficult, Creaven says.

“They present themselves well and are not seen as homeless,” Ms. Creaven says, “And when asked these mothers will whip out their children’s immunization cards, and they’ll be up-to-date! That’s impressive when you think of the barriers they face.”

SOURCE: America’s Youngest Outcasts by the Campaign to End Child Homelessness

The clinic’s staff takes a “broad approach” to health, trying to address all the issues that are contributing to their health problems.

This means addressing social issues, such as finding a job or getting enrolled in school, that the shelter residents may see as a greater priority than their health.

Only then will some acknowledge having other problems, such as depression or experiences with abuse.

“They try to present themselves in the best light, saying ‘I’m OK, I just need housing.’” says Creaven.

This is not surprising, says Creaven, they’re proud and “they’ve often had bad experiences with the system, so trust is a huge issue–a big part of our job is to build that trust.”

When that trust is established, Creaven says, a family will often come forward with other issues that the family has been trying to deal with on its own, such as problems with drugs and alcohol, a history of sexual abuse, depression and anger. “It’s like working through the layers of an onion,” she says.

But when they open up, there are a lot of services available for families willing and able to take advantage of them, says Creaven. “A lot people would think this is the worst place to end up in, but it can be an opportunity to move forward.”

In Cynthia Nice’s case, things are looking up. Her daughter is doing well; she’s gotten her G.E.D and is in professional office assistant training program, and her grandchildren are enrolled in day care and day camp.

Nice expects to move out of the shelter into subsidized apartment soon, and, since she has 25 years of experience working in retail, getting work again. And, with treatment, her blood pressure is down.

Sitting in the neatly kept shelter apartment tending to the two rambunctious boys, Dovantae and Larry, Nice says she’d rather be in her own place but that she’s thankful for all the help she’s received  “Things could be better, but they could be a lot worse: we could be living in my van.”

To learn more:

• Read National Center of Family Homelesssness’ Washington State Report Card:  http://www.homelesschildrenamerica.org/states.php?state=WA
• Read the King County Health Care for the Homeless Network’s 2009 Annual Report.
• Read the Ten-Year Plan to End Homelessness in King County.

Local Resources:

• 2-1-1 a telephone hotline to help you find resources for families and individuals in crisis. Either call 2-1-1 or click on the image below.
• King County Housing & Community Development Homeless Programs, which has links to additional resources.
• King County’s Health Care for the Homeless Network
• Sound Mental Health: www.smh.org
• YWCA Seattle/King/Snohomish: www.ywcaworks.org
• Washington State Coalition of Homelessness (http://www.endhomelessnesswa.org)
• King County County to End Homelessness’ website.
• United Way of King County resources for the homeless webpage.

National Resources:

• The U.S. Substance Abuse and Mental Health Services Administration’s Homeless Resource Center
• National Center on Family Homelessness
• Campaign to End Child Homelessness
• National Health Care for the Homeless Council

Tags: Health, Homeless, Homeless Children, Homeless Families

Category: Alcoholism, Asthma, Child & Youth Health, Drug Abuse, Mental Health, News