On a single night in January 2013, there were 610,042 homeless people in the United States.  Sixty-nine percent of them stayed in sheltered locations and 31 percent were found to be in unsheltered locations such as streets, abandoned buildings, and cars.  According to the report entitled: “The State of Homelessness in America 2014”, nearly 137,000 of these homeless persons reside in California.  The most notable difference between older and younger homeless adults is the older adults’ compromised health status.  One study found that 85% of homeless persons over the age 50 reported at least one chronic medical condition.  Homeless adults between ages 50 and 62 often have healthcare needs similar to those of people who are 10 to 20 years older. They often end up in nursing homes due to a lack of other options.  About 12 years ago the American Bar Association’s commission on law and aging estimated that 4% of Long Term Care residents are “unbefriended” – incapacitated and alone. Chances are your facility may have one or more of these residents.

Many life factors can ultimately lead to homelessness.  Some contributing factors may be cognitive deficits, drug or alcohol abuse, and mental illness. Mental illness has been listed as the third largest cause of homelessness for single adults.  Many homeless individuals may have been estranged from their families for years.  Families having lost contact with their homeless family member live without knowledge of whether their son, daughter, husband, wife, mother, father, sister or brother are dead or alive and never have a sense of closure.  These family members live daily with the mystery of not knowing.  Are there “unbefriended” residents within your facilities with such a background?  What are we doing within our facilities to find the families of these residents?  To reconnect them with those who may never know their whereabouts otherwise?   

This human interest story is one of joy and reconnection for one of the residents at a Sonoma County LTC facility and his family of two sisters. At Thanksgiving this year they had a lot to be thankful for as they celebrated becoming reunited after a decade of separation.

A previously homeless man, “Randy”(name has been changed to protect his identity), who had lived on the streets and in occasionally in a local Rescue Mission, was admitted to one of our LTC facilities in 2009 after suffering a stroke resulting in gait ataxia with multiple falls and expressive aphasia.  His other diagnoses include Hypertension, BPH with urine retention, Hypothyroidism, Dyslipidemia, Vitamin D deficiency and Schizophrenia.  Given his ataxia, multiple health issues, speech difficulty and the personality traits associated with his mental health diagnosis he was not able to discharge into the community and he was never able to provide the names of family members or close friends.  He remained “unbefriended” since his admission.

After suffering another stroke this past year with significant dysphagia and resulting weight loss, he was referred to Hospice.   Although not actively dying at this time, his strength and mobility have continued to deteriorate along with a nearly 40# weight loss over the past year.  He has remained comfortable and well cared for by staff meeting all his ADL needs.

As I rounded on him for a routine regulatory visit last month it dawned on me that in light of his chronic conditions and progressive physical deficits, I have nothing to offer him from a medical standpoint, as there is no physical cure.  The only offering I had was to attempt to provide social, relational and spiritual comfort if he would take it.  I followed my intuition as I sat by his bedside and asked the questions, “Is there anyone that should know you are here?”  “Do you have brothers or sisters?”  To my amazement, he said yes.  He had a sister.  When I asked him “Where does she live; in California?”  He responded by telling me the State she lives in.  I asked “What is her name?”, and he spoke it.  Not being certain I understood his garbled speech, I handed him a piece of paper and a pen and asked him if he could write her name.  To my amazement again, he clearly wrote down the names of his two sisters.  I asked him if he wanted me to try to find them for him and he said yes.

It was a moment of elation as I walked to the Social Services department to ask the staff to attempt to find this resident’s family.  I also called his Hospice RN to report the unfolding news.  Within a week, social services had located and contacted his sisters. Overjoyed to know his whereabouts, they flew to California together to stay for 15 days to reconnect with their brother.  It was truly a triumph in every regard.  These sisters were delighted to know where he is after all the years of wondering and grieving his loss to them.  They were able to accomplish a lot during their visit.  They loved him, amused him, brought him his favorite coffee and sat by his bedside.  Advance Directives were discussed and reconciliation was a gift they all shared!  The facility hosted a very special celebratory Thanksgiving dinner for this resident and his family that was an amazing tribute to the bonds of human caring.

Lessons Learned:

1.     Residents who were previously homeless, with mental health issues or “unbefriended” must have someone somewhere who cares for them and wonders what may have happened to them.

2.     Residents who initially decline to share information may be willing to give information on family members or close friends if approached in another way at another time or if conditions change.

3.     Utilize all resources at your disposal to attempt to locate family members:  Old health system medical records, the Ombudsman, homeless shelter, police department, Facebook or other social media, NAMI or the Center for Missing Persons  www.ncmissingpersons.org

4.     Never stop asking…

The result of reuniting the “unbefriended” with family or those who care may be the best “medicine” one has to offer a resident who is incapacitated and alone, and the rewards extend beyond the moment to a lifetime for all those involved; resident, family and the staff caring for them.

References:

1.     http://b.3cdn.net/naeh/d1b106237807ab260f_qam6ydz02.pdf

2.     https://projecthome.org/about/facts-homelessness

3.     http://www.csh.org/wp-content/uploads/2012/01/Report_EndingHomelessnessAmongOlderAdultsandSeniorsThroughSupportiveHousing_112.pdf

4.     http://ltcombudsman.org/uploads/files/issues/Informational-Brief-on-Unbefriended-Elders_0.pdf

5.      https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers#sthash.fEn4MZih.dpuf

6.     http://www.nationalhomeless.org/factsheets/Mental_Illness.pdf