Barnes-Jewish program finds temporary housing for homeless patients who frequent the ER

ST. LOUIS — D’Angelo Lockett felt better staying on the concrete slab behind the social service agency that helped him with medications for schizophrenia and bi-polar disorder.

“There was a security guard around,” Lockett said. “He used to watch us.”

Lockett, 32, would keep watch over his girlfriend while she slept. He would sleep when she woke up in the morning.

On the streets, Lockett had been robbed of his medications, eyeglasses, bike and even the paper mache he made of his favorite character, the Tasmanian Devil. He got into fights. He suffered a broken nose and a broken arm.

That’s when Lockett discovered another place where he felt safe — the emergency room at Barnes-Jewish Hospital. He began going nearly every day.

“I just say, 'My back hurting, my feet hurting, my head hurting,'” he said. “I just sit there for hours until the doctor come see me.”

Lockett was chosen for a new program at Barnes-Jewish that aims to help people like him: Hospital to Housing. Social workers at the hospital offered him temporary housing, as well as services for his bi-polar and schizophrenia — and to get him off the streets for good.

Lockett got an apartment in September and hasn’t been to the emergency room since. He falls asleep in bed listening to music. He has food on the shelves and a place to wash his clothes, shower and shave. He can focus on what he needs to do to get better.

“It’s good. Peaceful. Quiet,” Lockett said. “You can breathe when you want to. You get a peace of mind when you are by yourself.”

About five years ago, Barnes-Jewish began offering patients like Lockett an opportunity: temporary housing with support services that aim to get them healthy and into a permanent home.

Since then, with the help of funding from the Foundation for Barnes-Jewish Hospital and homeless services provider St. Patrick Center, over 70 participants have been placed in homes through the Hospital to Housing program. They are housed in a 25-unit building that the St. Patrick Center operates or with participating landlords.

Barnes-Jewish reports a 63% drop in emergency visits among participants in the 90 days after they are housed, and a 43% drop in visits a year later.

It costs about $9,300 to support one participant, which results in more than double the savings for the hospital, said Dr. Randall Jotte, a Washington University emergency physician at Barnes-Jewish. That doesn’t count savings to Medicaid, if the participants use the public insurance, and to other area emergency departments the patients visit.

“For a very challenging subset of the population that interacts a lot with the healthcare system, I think it’s been very successful and effective,” Jotte said. “My goal is to share it with others and expand it.”

'Familiar faces'

Lockett grew up in Memphis. He remembers being bullied for his size and for how he talked and dressed. He got into fights after school. His mental illness surfaced in his 20s.

He eventually came to St. Louis to live with family members, but his behavior spiraled. He was suicidal. He ended up in a group home with other people struggling with mental illness.

He tried other support programs but struggled to find the right medications and hold down jobs. He ended up in jail for taking a friend’s car to the store, he said. Finally, an aunt he was staying with was evicted.

He was homeless for about two years, he said, washing people’s cars and carrying their bags for money. He slept in a tent wherever he could. He racked up criminal charges for trespassing and fighting.

“You have to look at it like this: If you were homeless, where would you go? What would you do?” he said. “I felt like I could go the hospital and talk about anything with them, and they understand me.”

Homeless patients like Lockett are not uncommon in emergency rooms, doctors say. They are known as “frequent flyers” or “high utilizers.”

Jotte prefers to call them “familiar faces.”

The patients are not only homeless, Jotte said, but they also have serious mental health disorders or brain injuries that have gone untreated. A staggering number — about a third of the patients, Jotte found — have had traumatic brain injuries from an assault or stroke and can only function at a certain level.

Some of them arrive at the doors of Barnes-Jewish Hospital 50 to 60 times a year, he said.

“We’re kind of like their only network, the only safe place they often have. They have nowhere else to go,” Jotte said. “And they’re not on death’s door, but they’re not very well either.”

Tiffany Lovelace-Taylor, a social worker at the hospital, said shelters are often full or inaccessible, as clients struggle to follow the rules. Emergency departments are always open, and anyone who comes in must be seen.

They “can get out of the weather. They can get something to eat. They can get some sleep," Lovelace-Taylor said. "Whatever need they have at that moment, they likely can get it filled here, even if it’s just temporary.”

And no matter what treatments they receive, they often return, Jotte said, complaining of the same aches and pains. The patients take up valuable time and resources in busy emergency rooms, but they also continue to suffer.

“It's the same old cycle, and it's frustrating because you feel like you're not doing a very effective job,” he said. “You're missing something, and you don't know what you're missing.”

They may have seizure disorders, breathing problems, hypertension or diabetes — issues that can be addressed with visits to a clinic. But the patients struggle to make appointments when they can’t meet their basic needs.

“It’s hard to make progress with someone who is in need of some stabilization” Lovelace-Taylor said.

'Build a level of trust'

The Barnes-Jewish program identifies the 20 highest users of the emergency department over a three-month period. Hospital social workers then dig into the files to see who is unhoused, single and suffering with mental illness or substance abuse.

Lovelace-Taylor said it’s not uncommon to see some patients nearly every day, sometimes even multiple times a day. A social worker will approach the patient about receiving temporary housing and help through the St. Patrick Center.

That’s where the challenges begin. Patients often turn down the first offer. They think it’s too good to be true, or they’ve had a bad experience with another program.

“It takes being OK with being told no and not giving up,” Lovelace-Taylor said. “You have to build a level of trust. They get to know us, and we get to know them.”

If they agree, homeless services coordinator Emily Brandt from St. the Patrick Center meets with them. Brandt helps connect patients to the services they need, such as doctor visits, job training, bus tickets, cell phones and clothing. She also helps with securing documents such as Social Security cards. And she’ll take them to get everything they need for an apartment — dishes, linens and cleaning supplies.

Then she drops them off with keys to their new home, which comes with a bed, table and two chairs.

“They’ll ask, ‘Can I have a broom and a mop? I want to keep it real clean,’” Brandt said. “They take pride in that little apartment I give them.”

Sometimes, however, an apartment is not immediately available. The client goes on a waiting list but can later be hard to track down.

The transition to permanent housing is even more of a challenge. The temporary, free housing is available only up to 90 days, with some possible extensions.

“That is the hardest part for sure. There’s not enough affordable housing,” Brandt said. “I can’t tell you how many people have to go back to the streets because there’s nowhere else to go.”

Figures provided by Barnes-Jewish show that fewer than half of the program participants move on to permanent housing.

Lockett applied for an apartment in a subsidized complex, despite its backlog of applications. Brandt and Places for People, a St. Louis organization that helps people with mental illness, are working with Lockett to find other options.

Someone with Places for People visits Lockett nearly every day, filling his medication planner for the week, providing counseling and making sure he has food. They also help with obligations stemming from his criminal charges, such as community service.

Lockett said he wants to return to the community college classes he signed up for when he was homeless. And he eventually wants to become a truck driver.

“Now I have a home, and I can focus on my health,” he said. “And then I’ll be able to focus on my college.”