January 10, 2023 – Tashi Taliaferro doesn’t want anyone to die alone.
After more than 30 years as a nurse – 12 of them as a hospice nurse – Taliaferro has always felt comfortable dealing with the sick and dying.
What worried her was the number of her patients who died without the comfort of family or friends.
“We see people who are in their 80s or 90s and don’t have families. We see veterans and homeless and underserved forgotten,” says Taliaferro, associate director of nursing at Advanced Nursing + Home Support, a home health care company in Rockville, MD. “We were there with people who didn’t have anyone and it goes straight to my heart.”
Taliaferro is in the process of opening a residential home for the homeless and chronically underserved in her community of Montgomery County, MD, outside of Washington, DC, which has one of the highest Rates of the country’s residents living in poverty. More than every night 4,410 people in the country’s capital are homeless.
“No one should die alone unless they choose to,” says Taliaferro. “I think everyone, no matter how old or young or rich or poor or whatever their background, deserves the utmost integrity, grace, compassion and love.”
The growing demand for apartments in old buildings
As the baby boom generation grows older, the number of caring relatives will no longer be sufficient for this task. AARP Policy Institute estimates that by 2030 there will be four potential caregivers for every person over 80. That compares to a 7-to-1 ratio in 2010. By 2050, those numbers will drop to 3-to-1.
Of course, the homeless population is also aging. A report from 2019 from the University of Pennsylvania predicts that the number of people aged 65 and over experiencing homelessness in the United States will almost triple over the next 7 years, from 40,000 in 2017 to 106,000 in 2030.
Homeless Americans age prematurely, the result of the chronic stress associated with living in shelters, on the streets, and couchsurfing. The phenomenon is known as “weathering,” an area of particular interest to Rebecca Brown, MD, MPH, a geriatrician and assistant professor of medicine at the University of Pennsylvania at Philadelphia.
Brown’s work found that people 50 and older who are homeless have similar or higher rates of geriatric disease, cognitive impairment, urinary incontinence, frailty, and difficulty with basic daily activities such as bathing and dressing than people in the general population with a median age of 80
“They get these age-related diseases when they’re younger, and then, not surprisingly, they die earlier, too,” Brown says.
Many who have a terminal illness like cancer will be self-sufficient in homeless shelters for as long as possible, according to Travis Baggett, MD, research director for Boston Health Care for the Homeless Program.
“But once they can’t get out of bed on their own, or they can’t bathe, or they need oxygen, which most shelters won’t allow, they can’t stay there,” Baggett says.
These people may cycle back and forth between hospitals or nursing homes, where they receive medical care until their death.
Taliaferro has worked with Emily Cavey, a professional photographer and end-of-life doula. Like a birth doula, Cavey provides psychological, emotional, and physical support to dying individuals and their families. The couple bonded after Taliaferro coordinated the care of Cavey’s dying loved one through her job and found that they shared a similar desire to help people in the final stages of their lives.
Taliaferro told Cavey about their idea of a residential home to give underserved and formerly homeless people a chance to die with dignity, and they eventually formed the Good Hearts Foundation, a nonprofit organization, to raise money for their business.
They are still in the early stages of finding a potential donor for a suitable home for the surgery, as well as other sources of funding such as grants to set up and run the home.
It is currently unclear how the home will be licensed or approved. Taliaferro and Cavey are also working on what type of license they need to work as a dorm; County officials in Maryland initially thought the couple would need a hospice provider license. But the home itself will not provide medical services. Residents may bring in outside healthcare providers to provide services, but there will be no financial ties between the residential facility and these companies.
They already have a name for the first home: Maddie’s House, after Taliaferro’s mother, who died in a car accident when Taliaferro was 2 years old. They hope to open in 2023.
The Grace House: A model nursing home for the homeless
Taliaferro got her spark for Maddie’s House after learning about the Omega Home Network, a membership of 40 dormitories and other homes in development, all serving the same purpose of helping people who would otherwise be living alone in their final days to provide a loving environment.
The Grace House, a nursing home in Akron, OH and part of the network, opened in September 2022 for terminally ill people.
The facility is funded by grants and donations and has three requirements for residents: they must be enrolled in a Medicare, Medicaid, or private insurer hospice program; they must have limited financial resources; and they cannot have anyone else to house and care for them. All services are free for residents.
Holly Klein, a registered nurse and founder of Grace House, routinely cared for homeless patients during her 14 years as a home hospice nurse in Akron.
“I use the term ‘home’ very loosely because it was really where the patient lived,” she says. “I met people under a bridge, in motel rooms, in homeless shelters and some just in degrading living conditions. Watching people die alone in these conditions was draining and I started to ask myself, ‘Isn’t there more we should be doing?’”
Hospice providers — who have no financial ties to Grace House — visit individual residents regularly, just as they would if residents had their own private home, to manage clinical care, while home staff provide 24-hour care to residents Cooking, cleaning, personal hygiene and administering medication.
“We see ourselves as a surrogate family,” adds Klein. “And anything that a hospice program can teach a family to do at home, they can teach our staff, such as: B. easy dressing change and education about medication.”
Since opening, 16 residents with terminal illnesses such as heart and kidney disease have come to Grace House to live and die within its walls.
Five residents were homeless before they arrived, and several came from homes “that they literally raided or had no running water, electricity, or heat,” says Klein.
Grace House residents who have lived alone for years may enter the facility withdrawn and suspicious. But many form friendships with each other, with staff and volunteers — and even reconnect with estranged loved ones in the final days and weeks of their lives.
“We provide the environment that makes them feel safe and secure, which allows them to let go of some of those walls and old habits and reconnect with people,” says Klein. “It was amazing to see.”