Homeless Healthcare Los Angeles: The Dignity of Choice

The second of a two-part series on the services provided by Homeless Healthcare Los Angeles.
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The gravelly squeak of a shopping cart’s wheels against the cracked sidewalks of Skid Row pierces the hot silence of a March day in Los Angeles. In the middle of the handful of streets called the epicenter of the Los Angeles homelessness epidemic, only a handful of cars pass by, and no pedestrians.

Inside the Center for Harm Reduction a block away, it’s even quieter.

A homeless man sits next to a shopping cart carrying his possessions, a little more than two blocks from the Center for Harm Reduction, run by the Homeless Healthcare Los Angeles.

The building, next to the Los Angeles Needle Exchange, houses an array of programs designed by non-profit Homeless Healthcare Los Angeles to help the homeless cope and adjust to their new lifestyles once they’re off the streets.

“We see people on the streets at the Beverly building, we meet people coping with drug issues at the Needle Exchange, and here, we’ve progressed to people who are in the aftermath of all that turmoil,” said Delia Mojarro, the Community Assessment Service Center director for HHCLA. “We saw this program as a missing piece to all the services that we offer.”

On opening day at the end of March, almost no one came in. But in the two months since CHR’s annex opened, more than 15 people have begun working with a case manager. Once the center is in full swing, case managers predict a load of more than 100 clients.

Bright walls, polished cement floors and angular modern furniture lend a sleek yet inviting atmosphere to the new building.

“This is a more holistic atmosphere,” said Angelica Skouras, case manager and HIV service advocate. “We’re providing outlets from anxiety and offering alternative methods so they can flourish.”

One sign inside Homeless Healthcare Los Angeles encourages clients to take their treatments one step at a time.

To qualify for the center’s free services, clients must be living in single-room occupancy buildings or the Skid Row Housing Trust. HHCLA is overseen by Los Angeles County and funded through a combination of private donations, government money and grants, but the Center for Harm Reduction is funded entirely through private donations that require employees to focus on clients living in SROs.

Eligible clients can choose from an array of services, ranging from the more serious – case management, HIV counseling and testing and emergency overdose response training – to creative and social activities like art lessons, bingo or “coffee and a morning walk.”

“We ask the clients, ‘What is it that you need?’ instead of telling them, ‘This is what you need,’” Skouras said. “Part of the principle is to give people the dignity of their own choices.”

All services that HHCLA provide are highly individualized, Mojarro said. Each client copes in different ways and needs different outlets to get back on his or her feet. By working with a case worker, clients can be referred to mental health agencies, drug and alcohol treatment programs, emergency shelters, food pantries and other social services.

“A lot of us know how to deal with crisis, because we’re so used to being in crisis mode,” Mojarro said. “But what happens when that crisis is over? How do we deal with that time? With ourselves?”

One of the more unique services HHCLA offers is acupuncture, available twice a week. The treatment is supposed to help clients relax and cope with cravings.

At the Needle Exchange next door, clients can attend overdose response training, where they watch a video and a Powerpoint presentation, then practice hands-on emergency reponse training. They learn to administer Nalaxone (sometimes called Narcan), a drug used to treat opiate overdoses. And at the end of the session, they receive an overdose bag (ODB) to use if they or someone they’re with overdoses.

The Needle Exchange also provides sterile needles, case management, wound and abscess care, HIV and other STI testing.

Sometimes, clients believe that traditional doctors and hospitals won’t properly treat them if they’re drug users, Skouras said. Some believe their wounds aren’t properly anesthetized or treated, or that overall their quality of care is lower.

“Our doctors are humane, and it’s with dignity,” Skouras said. “I think that helps us develop a relationship with our clients so that they feel more comfortable to come in again.”

For those who are estranged from their families, entertaining guests is difficult because SROs are studio-sized apartments with no space to have people over.  So CHR can be a place to simply be.

But getting that housing can be an upward battle. To help its clients get into permanent housing, HHCLA provides an intensive case management program called Accessibility to Housing and Health that helps the homeless qualify for Section 8 vouchers.

To qualify, clients must have income, a chronic medical condition and at least two recent admissions into the hospital, said Elda Lazaro, director of AAH. The program is known as highly demanding and intense: for a year, AHH checks in regularly with its clients to make sure they’re on track.

Since 2008, the program has placed more than 115 people into Section 8 housing, but the number of clients is based entirely on how many Section 8 vouchers are available. AAH received new vouchers this month and is now accepting new clients.

“Our program is unique in that we do the intense case management so clients don’t fall through the cracks,” Lazaro said.


About ljnelson

Laura is a student journalist based in Los Angeles whose work has appeared in multiple metropolitan dailies, including the St. Petersburg Times, the Los Angeles Daily News and The Kansas City Star. She is a junior at the University of Southern California majoring in French and print and digital journalism.
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