Post hospital stay is whirlwind of beds, programs

On a morning in late August, 57-year-old Mary Manning (a pseudonym, at her request) was resting on her sister Jackie's porch. She was midway through a rugged course of chemotherapy for breast cancer. Manning looked at her younger sister and said, “You know, I’m dying, sister. I think this poison is killing me.”

When Jackie went to check on Manning later in the day, she wasn't at home. Calls to her cell went unanswered. Finally, at around 10pm., a nurse from Cottage Hospital called to inform her that her sister was in a bed on a medical ward there, receiving treatment for pneumonia, diarrhea and dehydration. “I went to visit her the next day and she was almost dead,” recalled Jackie. She said Manning was curled up on the bed in a fetal position.

After about ten days of acute care, Manning was released to Casa Esperanza. Like William Richardson, and other homeless hospital patients, Manning had nowhere else to go. The landlady who'd been renting her a room in a house near San Andres Street had recently told her she had to leave, that she was too sick to live there anymore. With only $600 a month in Social Security Insurance (SSI) coming in, there was little else she could afford in Santa Barbara, and Jackie, with small children to care for at home, couldn’t take her in either.

Because Manning did not sign a privacy waiver, some elements of this story haven’t been verified, including her diagnosis and the length of her two hospital stays. Yet both women clearly recall the afternoon Manning was discharged from Cottage Hospital. They said they arrived at Casa Esperanza around 4:30 but were quickly informed by the shelter's staff that Manning was too weak to stay in a medical bed there.

Even though all the usual procedures for Cottage referrals had been followed – the paperwork had been sent over by discharge planners and approved by shelter staff – once they saw Manning in person the staff deemed her too weak to remain. She couldn’t get herself to the bathroom or the cafeteria without help.

“Take this piece of paper and go back to Cottage,” Jackie recalled shelter staff telling them. Manning was reportedly in tears. The nurses balked at re-admitting Manning to ER, but later, a doctor admitted her to a room and she remained there for another week receiving treatment. This time around, hospital discharge staff worked to get her a bed at a skilled nursing facility. Manning is lucky enough to have both Medi-Cal and Medicare, so she, unlike many homeless people, was eligible for a bed at Mission Terrace. Still, the bed was made available to her only for the time it took to build her strength up. After that, she would have to go back to Casa Esperanza.

That was the plan.

I met Manning the day after her arrival at Mission Terrace. She welcomed me to a room she shared with three others, and generously agreed to let me write about her situation for my project on medical discharges of homeless people.   

Mary Manning’s fall into homelessness is at once unique and all too familiar. She’s a Santa Barbara native, actually. She grew up in a house near Las Positas Road, graduated from Santa Barbara High, and worked as a waitress on and off while raising two sons. But she lost her husband 15 years ago, and 12 years ago was diagnosed with breast cancer. She seemed to be out of the woods – but last summer, the cancer came back. The timing could not have been worse, as she had just lost the rental she’d had for years, when the property was sold.

Though a bed at Casa Esperanza was plan A for Manning after her stay at Mission Terrace, behind the scenes, caseworkers at Cottage and Casa Esperanza were working to get her into WillBridge. This small residence for mentally ill homeless people also accepts some homeless patients on discharge from the hospital, for recuperative care. Manning was hoping to go to WillBridge over Casa Esperanza, where instead of 30 roommates, she could have one.

But it was not to be. By Friday, September 9, Manning had regained enough strength to leave Mission Terrace. There was no bed available at WillBridge, so she was sent to Casa Esperanza and settled into the upstairs women’s dormitory.

A few days later, I dropped in to check on her. Slumped in a large armchair in the shelter’s cavernous lobby, wearing a down vest and leggings, she had a pale and resigned expression. Her purse was at her feet and the Nebulizer she needs to use five or six times a day for Chronic Obstructive Pulmonary Disease (COPD) was tucked next to her in her chair.

When I asked how she was she answered in a single word.

“Tired.”

When I asked if she felt she could get well here in the shelter she said, “No. Too many people. I’m just not used to it.” But then she paused and added, “Still, I’m grateful it’s here.”

Manning stayed at Casa Esperanza for a week. Each time I visited, she had the same resigned, tired, pale, and unhappy expression. On top of the difficulties of having cancer and being homeless and broke, she was also having to jump through hoops to get her medicine and the Nebulizer she needed to keep her lungs open. Apparently, Mission Terrace had not "aligned" her medication before discharging her to Casa Esperanza. She had some medication, but not enough to last her, and the Nebulizer they gave her was broken. When her meds ran out, the only refills available were through CVS for $110 – money she did not have. Ultimately, her prescription was filled through the county, and a Nebulizer was found, but only thanks to the persistent advocacy of Casa Esperanza’s medical coordinator, Jan Fadden.

On the 16th of September, a room at WillBridge opened up for Manning. Program Coordinator Nick Ferrara interviewed her first, and all the arrangements were made. Except . . . the day she was meant to move, she was once again out of medications. Ferrara could not safely allow Manning to stay there without medications vital to maintaining her breathing. So again, late on a Friday afternoon, Manning was directed to Cottage Hospital’s Emergency Room to get her medication. She was there several hours, but made it to WillBridge in time to spend the night. When I saw her on Sunday morning, she was wearing make-up and a bight pink sweater.

She said that living in close quarters with ten other people was taking some getting used to, but overall she was happy to be at Willbridge, where case managers would be helping her to get a housing voucher and other kinds of help. “Where it's not just a dead end,” she said.