Projects Offer Health Care, Counseling : Amid Despair, Progress Made in Aiding Homeless

Second of two articles

In a tiny, back-room clinic at the Antonio Olivieri storefront shelter for homeless women in mid-Manhattan, Dr. John McAdam looked up from a patient. “When we see people, they’re usually really sick,” the young physician said. “It’s like wartime medical practice.”

But the clinic is more than “M*A*S*H” in an urban setting. It is part of an extensive coast-to-coast demonstration project designed to bring medical care directly to places where the homeless congregate.

It is just one example of a hidden side of homelessness in America--potential progress that has been largely overshadowed by the riveting tragedy, drama and despair of life in the streets.

On a counter nearby, the clinic’s logbook offered a litany of tragedy: frostbite, rape, flu, hypertension, abdominal hernia, a complaint of “bugs.” The bugs, doctors found, were imaginary--a flare-up of mental illness brought on by the death of one elderly homeless woman’s closest friend.

McAdam, dressed in an ordinary plaid work shirt, examined a middle-aged woman who wore a maroon cap, a black shirt and dark slacks rolled up to reveal an infected leg. He took her temperature to be sure that the infection had not spread. As he worked, the sound of coughing just outside the clinic’s door mixed with the conversation of homeless women waiting at the shelter for a hot lunch.

“We see a lot of TB, a lot of infectious problems,” McAdam said. “There’s usually a lot to do when you leave the door open.”

Some social workers say that vivid television pictures of destitute men and women huddled in doorways and newspaper stories about deep cuts in social programs by the Reagan Administration divert attention from a range of promising projects that are under way to help the homeless.

Many of the projects are tentative and their impact must be weighed against the growing magnitude of the homeless population. But, the experts say, the programs constitute progress. Some examples:

--With little publicity, New York City has launched the largest program in the nation to permanently house the homeless. More than 4,000 apartments, mostly in city-owned buildings, have been renovated. Volunteers from churches and synagogues welcome new families as they move into neighborhoods, act as baby sitters and guides and help in arranging schooling, social services and medical care.

--In Philadelphia, some of the homeless are being assisted in becoming street-corner entrepreneurs. They work at produce stands or as vendors selling hot dogs and other fast foods. A percentage of the worker’s salary is deducted each week and put aside so that, within six months to a year, the homeless person can own the business.

Training as Mechanics

--Street people in Portland, Ore., are training to become auto mechanics in a specially run garage that charges lower rates for repairs than ordinary garages. A neighborhood recycling project is under way. Some of the homeless are given shopping carts so that they can collect bottles and cans that can be turned in for cash.

--In California’s Silicon Valley, a computer network has been set up to link families in shelters in Santa Clara and San Mateo counties with available apartments. Information from newspaper classified ads and other leads are posted on an electronic bulletin board that can be called up by computer in each shelter. Using the computer network, one homeless Boston woman who arrived in California with her three children found both a job and a house within 18 days.

Many of the projects to aid the homeless have grown out of local needs. Viewed individually, they seem fragmentary efforts. But community organizers contend that, collectively, they could serve as a framework to solve some of the most pressing problems of homelessness in America, especially if supported by enough federal funds.

“How many photographs do you see of people who got off the street and have jobs?” asked Mike Stoops, a community organizer who works with the homeless in Portland, Ore., with exasperation in his voice. “It is possible to help the homeless. They are not deadbeats. They are not homeless for life.”

Diverse Population

Social workers and others who deal with the homeless also stress that a wide range of options is necessary to deal with a very diverse population.

The needs of panhandlers, derelicts and bag ladies are far different from those of a family suddenly forced into the night by an apartment fire. De-institutionalized mental patients wandering the streets have problems requiring other solutions. The new and temporary homeless who are forced into shelters by welfare cuts, family crises, automation or plant closings have still other needs.

“The homeless have become a kind of generic, or code word,” said Mitchell Ginsberg, professor of social work and social policy at Columbia University, who served as New York City’s welfare commissioner in the 1960s.

“Actually, the homeless are made up of a mixture of different things,” he said. “They differ by age, they differ by sex, they differ by what you can do for them. Yet it is convenient and easy to lump them together as homeless. . . . We suffer from a lack of planning because we have not understood that we need a range of options. The cases are different.”

But despite the diversity, an obvious fundamental need cuts across all categories of the homeless--the need for housing.

Many in New York City

“Housing is the bottom line. There is no way around it,” said Leslie Lannon, coordinator of the Childrens Aid Society of New York’s homeless project.

Many of the new approaches are concentrated in New York City because of the size of its homeless population. More than 30,000 persons may be without shelter on any night in the city.

Just off the East River, near a playground in lower Manhattan, is a pioneering project to help the homeless in family groups. Such centers are rare in the United States. The Henry Street Settlement Urban Family Center combines an apartment complex containing schools with a separate building for battered women. Case workers and city housing officials have offices there to aid families sent to the transitional shelter.

“We get a crack at coping with difficult families in a social setting,” said Danny Kronenfeld, the center’s director. “For some of the youths, it is the first positive school experience in their lives.”

Family members can remain in the 97 apartments for up to eight months before they must find permanent housing. The majority move to public housing; about one-third relocate to private buildings. The rest generally return to single-room occupancy hotels.

Long-Term Shelter Urged

Kronenfeld sees the need for longer-term shelters than Henry Street--clusters of apartment buildings with social worker concierges. “We had a dozen people die when they left here,” he said. “We know they would have lived. Without the support, there is real deterioration.”

Because of New York’s severe housing shortage, more than 2,500 homeless families live in hotels, with rents paid by the city. The conditions can be deplorable, with mothers and children crowded for months into a single room, often without cooking facilities. Hotel corridors are turned into playgrounds because no outside recreation is available.

As a partial solution, social service agencies have begun trying to make the hotels more livable. At the Hotel Carter, less than a block from Times Square, an after-school program is under way, including tutoring and assistance with homework. A parents group discusses nutrition, housing and personal care. There are alcohol and drug abuse prevention programs and organized recreation for children.

“There are a lot of motivated, talented people,” Lannon said of the homeless families in the hotel. “These people are survivors. These people have made do with literally nothing. It’s a real inspiration. There are a number of really incredible people in that hotel.

“There are a lot of nice kids. Times Square is not a place to raise a child. Would you want your 7-year-old daughter walking around Times Square?”

Red Cross Project

Another solution is being attempted by the American Red Cross, which has leased a 92-unit hotel in midtown Manhattan. It will be used for homeless families headed by women with children under 8 years of age. There are plans for a day-care center to allow the women to search for permanent housing. Case workers and other specialists have offices in the hotel, which includes a small cafeteria.

“We are trying to demonstrate that even within the confines of a hotel setting, which is less than ideal temporary housing, a lot can be done to make it supportive and more cost effective than what is being done by the city in commercial hotels,” a Red Cross official said.

One of the nation’s most innovative programs is being run in Philadelphia by five former street people who have formed a committee to provide housing and job training.

Based at a local church, they offer shelter, counseling and job development--including the sidewalk entrepreneurs program where a portion of the vendors’ earnings are saved to set them up in inexpensive small businesses. The homeless are also paid $25 a week to attend job counseling classes, which include resume writing, basic office dress, math and English skills. Class members see themselves on videotape to learn how they appear to interviewers.

Homeless Make Up Staff

“A year ago, I was sleeping in an abandoned building,” said Chris Sprowal, one of the program’s organizers. “The Philadelphia Committee for the Homeless said if we secured a site and wrote a proposal, it would fund us. We received $23,700 for a shelter in the Methodist church. All our staff is homeless. People who came through the doorway had to make a commitment to the stabilization of their lives.”

One of the most pressing and paradoxical problems for the homeless is medical care. Many street people live within easy walking distance of hospitals where open heart surgery, organ transplants and the most sophisticated X-ray techniques are practiced. But the homeless population suffers from diseases that go hand in hand with neglect--illnesses such as tuberculosis, skin ulcers, scabies and other ailments routinely prevented and easily treated among the general population.

In 1969, an alert intern looked around the emergency room of St. Vincent’s Hospital and Medical Center in lower Manhattan and wondered why so many dead and dying men were being brought in. Dr. Arthur Kaufman wondered why they weren’t getting help earlier.

The men were traced to the Greenwich Hotel, an eight-story structure that housed the destitute. St. Vincent’s opened a clinic at the hotel, the beginning of what is now a vast experience with the medical problems of the homeless.

St. Vincent’s now operates clinics in four shelters and 14 hotels where the homeless congregate, including the clinic at the Antonio Olivieri shelter. The hospital administers 18 demonstration projects throughout the nation with $19.6 million in funding by the Robert Wood Johnson Foundation and Pew Memorial Trust. The U.S. Conference of Mayors is also a partner in the projects.

Providing better health services for the indigent is a complicated task. Normal treatment routines pose severe problems for street people. One example: insulin-dependent diabetes requires regular injections, a special diet and meticulous care of the feet to avoid infections. These can be huge hurdles for the homeless.

Insulin needs refrigeration and clean syringes are often stolen by narcotics addicts. Many of the homeless forage for food, so a proper diet is impossible. Foot care is the last thing on the mind of a homeless person huddled in a blanket in a doorway.

The problems can be multiplied by a dozen other diseases. Pills carried in pockets soon become crumbled powder. Viral infections can spread rapidly in crowded shelters.

Among many of the homeless, suspicion of doctors is high. “Because of the degree of alienation and fear and mistrust that is so chronically present in these people, they are scared of everything and they are angry,” said Dr. Philip W. Brickner, director of the Department of Community Medicine at St. Vincent’s.

‘We Are Here to Serve’

“We have to generate in them willingness to relate to us,” he said. “We have to get over to them the feeling we are here to serve them the best we can. It may take months. Every kind of tragedy can happen, and has.”

Psychiatric illness among the homeless increases the problems.

“Many (of the mentally ill) have not found effective, community-based services,” Brickner said. “They filter down to Skid Row, where they suffer without help. The basic prerequisites of life--food, clothing and shelter--have been removed. The snake pit probably was better than lying on a grate in the middle of a New England winter.”

L.A. County’s mental health programs--geared in part toward the mentally ill homeless--represent a bright spot in an otherwise bleak budget outlook. Part 2, Page 1.

Times researcher Siobhan Flynn contributed to this story.