One Nurse On Caring For NYC’s Homeless Residents During COVID-19

Back in June, the Coalition for the Homeless released a report that revealed those experiencing homelessness in New York City are 61% more likely to die from COVID-19 than the average resident. They reported that in June 2020 there were 58,736 homeless people, a number that includes 19,626 homeless children, sleeping each night in the New York City municipal shelter system — and people of color are disproportionately affected, according to the Coalition for the Homeless. Homeless New Yorkers are one of the most vulnerable communities that've been hit by the pandemic.

As medical director for Primary Care at the Center for Urban Community Service, Emily Gerteis provides essential resources and healthcare for homeless and unsheltered New Yorkers every day. Right now, her work includes treating patients in need of medical attention at shelters and in supportive housing programs. She agreed to take a few minutes out of her day to answer a few of our questions.

Emily Gerteis: "My wife has taken to making breakfast for me since my favorite coffee shop closed due to the pandemic. Back in April, we were both sick with COVID-like illness, and I probably gave it to her! Despite that, I’m feeling thankful to have a partner to quarantine with, to take care of each other.

"As soon as I walk into my office, clients start knocking. My office is in a big supportive housing building, so I have a clinic in an apartment building. The clients that I work with all got their housing because they have a history of homelessness, mental illness, substance use history, HIV/AIDS, or a combination of the above. 

"I’m used to being busy at the clinic but things are more hectic now since essential staffing means we don’t have any medical assistants. Also, clients are generally more anxious and really starved for connection. People have taken to knocking just to check in and say hello. When they knock, they’re asking about me, how I’m doing. It really brightens my day.

"I'll have a few walk-ins in the morning. I’ve been impressed at how people are taking the initiative to take care of themselves during this time, even though they have a lot to deal with.

"Social workers will drop off a bunch of patient medications and pillboxes in the afternoon. They normally help clients with their medications, but due to coronavirus, they’ve had to cut back on the amount of support they can give clients face-to-face, for everyone’s safety. Without reminders, it’s hard for some patients to manage their medications for chronic conditions like diabetes. But we’re doing the best we can."

"The average day before all of this had a lot more unstructured, in-person colleague office time. Now, with the way people are social distancing in the office and all of my staff working in different clinics throughout the week, none of us really overlap. We don't get together for any meetings anymore. I haven't seen some of my colleagues in six months. Obviously we see each other on Zoom, but that's very different from how things used to be. I think, especially in medicine, the need for a curbside consult or to run things by each other is how we work. It's part of our workflow, it's how we practice medicine, and to not have that time has been a big change for us.

"We're seeing about the same amount of patients, but the focus is a little bit different. Recently we've gotten back to the typical primary care focus of vaccinations, routine screenings, and things like that. 

“When the prevalence of COVID was really high in the city, we were foregoing all of that and we were talking about ways to keep them safe, we were talking about their fears. A lot of folks with mental illness are already really isolated. So to then not have senior lunch, for example, or not have their AA meetings available was a big, big shift. They've become a lot more isolated. A lot of our medical appointments were focused on mental health wellness, substance abuse, disorders, people who are struggling with the isolation. 

“It's shifting back now but we'll see what the fall has to offer."

“Now has been a time where we see folks who have really struggled with adhering to their medication. Without that extra support of really robust social work, a lot of folks have dropped off of being on top of their medications and being on top of their illnesses. I've seen it take a toll on people, where their conditions are getting worse. 

“Diabetes is a good example. People who were really controlled in their diabetes before have been really struggling to manage it in the pandemic. And again, these are the folks who for years and years and years were living on the street with a mental illness, with a substance abuse disorder. They're already kind of on the edge of not keeping it together. It takes a lot of years to feel like they really own what's going on with them and to take that ownership over their own health, when for so many years they weren't engaged with it or were sidelined by the system and didn't get the care that they needed."

"We found a client deceased last month. The social worker had called me up to his apartment. Because they can’t touch clients, it’s up to me to assess his heart rate and identify him as pulseless. I’ve known him for 6 1/2 years. He was almost 70 and most likely died of coronavirus. Being someone that grew up in mental health institutions, hospitals were like prison to him. So on Friday, when we asked him to go to the emergency room for being short of breath, he refused. And on Monday when we checked on him, he was dead. It’s so intensely sad. I’m heartbroken. But I remember that ultimately, it’s up to him to do what he wants to do with his life.

"I had a client who missed his appointment on Monday. I worry about him because one of the ways he manages his mental illness is to work. Since he’s been laid off, it’s been harder for him to cope. He says he’s okay, but I wonder how much he’s not sharing with me."

"Homeless people are just as afraid as we all are of this disease. Housing, in this pandemic, is healthcare. A hotel room instead of a shelter bed, that's healthcare right now. Giving people access to that is saving lives. Whatever was going on with us before the pandemic, whether it was depression or anxiety, they're all exacerbated right now. The same with homeless folks. Think about that as you envision what it's like to be homeless during a pandemic. We are very privileged to have our homes to quarantine in, although we are sick of it.

"Our patients are survivors. A lot of us, when we see homeless people on the street, we see their weaknesses. We don't see the strengths and the survivor mentality that they have and how they've been able to survive for so long. I feel privileged in my role that I can follow someone from not doing well on the street, to the shelter, to their apartment, to this real path of wellness. That's really gratifying for me. And I think if folks can envision that journey, it can really help the person that's on the street."

"A client came in earlier this week, telling me that he burned his beard while smoking a cigarette and he can’t get a haircut right now. So I cut his beard for him. He says I did a pretty good job. I’m glad because his surgical mask fits a lot better now. Plus, I like doing stuff like that. Something concrete, you can see the results right away. Satisfying. It’s not all the time that we get to see that in this kind of work. It’s usually slow progress in primary care, especially this kind of primary care. We are used to a lot of setbacks before we see any progress.

“This job is particularly suited to a whole person wellness program, which is why we have psychiatrists and social work and medical and nursing all wrapped up together at CUCS. One person needs all of those things if they've gone through what our folks have gone through. On one side of the coin, I really get to know my patients. I really get to understand their struggles and I get to develop care plans around what their goals are. In that way, we get to really work on the person as a whole instead of being like, ‘Yeah, just take this medicine and follow up in three months.’

“The other side is that I get close to my patients. So when someone dies I'm there to support the staff in that and pronounce someone dead. That's part of my job, and it's a really hard part of my job, especially when you get to know patients in the way that we do. The joys come with the sadness as well.

"Those little moments when you see progress and development in someone, that's a joy. To be able to get people who are really psychotic to wear a mask and understand why they're safe. That's a joy. It's those little moments when you see progress and when you have a win. Clinically, those are the things that are a big deal."