COVER STORY

PTs Donate Hands and Hearts

in Reaching Out to Help the Homeless

By Christine McLaughlin

Walking through the streets of nearly every major American city (and even some minor ones) part of the cityscape, unfortunately, includes people who are homeless. These people, who literally live on the street, are not just men and women, but children, too. And while it's a politically charged issue, especially this election year, one thing is certain, there are a large proportion of Americans who are homeless and need help.

In fact, according to a 1994 report by the U.S. Department of Housing and Urban Development called Priority Home! The Federal Plan to Break the Cycle of Homelessness, there were between 4.95 million to 9.32 million people who were homeless in the late 1980s. Yet the recession of the early 1990s has most likely worsened the problem.

Homelessness is widespread in the United States and health care is lacking among this group. Homeless people typically have at least one chronic health problem almost twice as often as housed people, according to the National Coalition for the Homeless, a nonprofit advocacy group based in Washington, DC. With the exception of obesity, stroke and cancer, homeless people are far more likely to have every category of chronic health problem. The reason: lack of appropriate health care.

TO HELP fill the void in their health care, physical therapists have become active partners in helping the homeless.

Roughly five years ago, Christine Chase, MS, PT, put together a PT program to assist the homeless in Pittsburgh called, "Hands-On for the Homeless." She told ADVANCE that the program was actually the result of a continuing education course she took that required students to design and implement a program within a three-month time frame. "I decided to do it because it was an issue that I felt was important to address. But it really never dawned on me that [creating a program like this] was something that was above and beyond the norm," said the therapist, who is president of Cardinal Concepts Consulting Services Inc., a contract therapy staffing service based in Pittsburgh.

Her program involved clinics placed in three different homeless shelters in the city, which were opened through an umbrella organization, Alma Illery Health Care for the Homeless Project. "The shelters already had existing medical clinics with physicians and nurses going in on a regular basis, so we built on that referral source," she said.

In a matter of three months, the three clinics were staffed with 17 volunteer licensed PTs and an association was established with two PT schools in the metropolitan area which involved several students. In addition, said Chase, about $15,000 worth of equipment was donated.

TWICE A WEEK for an hour each session, said Chase, the PTs at the participating clinics would treat "just about every diagnosis" including people with MS, neck and back pain and even paraplegia.

Because there was no guarantee that the patients would return to the clinics, the PTs tried to do as much as they could for them. "Our intervention would usually be based on education, and the therapist would choose one or two important exercises that could really make a difference for the person."

Part of the education would consist of basic care of the body, such as emphasizing protective clothing and appropriate footwear. The therapist might also stress when to look for radicular symptoms that result from certain biomechanical positions, i.e., swelling in an extremity. "The unfortunate thing for these folks is that it's difficult for them to help themselves because they're always in an environment that [does not] physically support them," noted Chase. "For example, someone suffering from hip, knee, ankle and foot pain has to be walking the street most of the day in shoes that don't fit well. It's difficult to have the opportunity [as a PT] to stop that problem."

Even though the shelter residents did express interest in therapy, after about two years, referrals for physical therapy began to taper off. "We sort of expected it to happen eventually. But we felt that even if we got the patients one visit it would be some kind of intervention they hadn't had before."

Chase called the doctors to let them know that the PTs were still interested in seeing the patients, but she conceded that she wasn't exactly certain why the referrals stopped. It could have been the fact that the doctors had one opportunity to treat the patients and physical therapy may have not been at the top of their agenda, she guessed.

DESPITE THE DEMISE of the Hands-On for the Homeless program, there is still an on-going "as needed" list of PTs who want to participate with the Alma Illery homeless program. Additionally, local PT students continue to express interest in volunteering. "I doubt that these on-going things would be happening now if it wasn't for the [Hands-On for the Homeless] program that we initiated years ago," added Chase proudly, adding that she continues to get calls from therapists who want do donate durable medical equipment.

The best part of her experience with the program, noted Chase, was that it helped her and other therapists touch a lot of lives and "recognize the gift that all people are in life regardless of socioeconomic status."

Echoing Chase's comment is Susanne Field, a PT student from Thomas Jefferson University who works on a similar program called "Hands of Hope." This program differs because it's student-run and conducted at one shelter--the Salvation Army Gateway Service Center in downtown Philadelphia. Along with OT students and medical students, Jefferson PT students volunteer their time to treat homeless men who stay at the temporary men's shelter, as well as some women who come on occasion.

For three hours every Thursday night, the PT students and local volunteer licensed PTs who supervise, have been treating homeless patients for the past three years. Field estimated that out of the three classes (first, second and third year) of PT students at Jefferson, most every student treats in the clinic at least once. "Most everyone [in PT school] knows about it and expresses interest in it--the program is very well-received," emphasized Field, who serves on the student steering committee.

Equipment donations come from various sources. Last year, for the first time in the program's history, it was given university funds to purchase additional equipment and supplies. This year, the clinic is fully equipped with hot and cold packs, a whirlpool, a stationery bike, a weight machine and elastic tubing.

"THE ONLY THING we don't have enough of is space. We have a classroom where we store everything and pull it out every Thursday to the PT gym, which isn't very big," said Field, who jested that a lot of physical labor is required of the students as well.

Because PTs at Hands of Hope cannot treat a patient without a physician referral, they work at triaging the patients with the medical students to determine if there is a need for therapy. If there is a need, then the attending physician writes the referral for the treatment.

According to Field, the educational experience of working with the homeless has been more extensive then she may have gotten from only working in her clinical affiliations. "It's really been exciting because I'm always getting a hands-on learning experience that is consistent throughout the year," remarked Field, who will be starting her third year at Jefferson and in Hands of Hope. "And it's neat to be able to learn something in class and go to the clinic that week and treat the same type of diagnosis."

Much like Chase's program, the diagnoses that the Hands of Hope PT students treat run the gamut. In the cold months, the focus is preventing future frostbite because many of the patients come to PT after they have already experienced it. "It's a lot of education on how to keep their feet clean and dry. And we will treat them in the whirlpool or with hot packs, if needed," Field noted.

In the warmer months, the clinic slows down because many people spend more time outside, said Field. However, there is always time made for those who do frequent the clinic for education on proper exercise and nutrition.

"So many of the homeless people that we treat are so excited to have someone educate them [about things like exercise and nutrition] because they may have never gotten that kind of education before," she commented. Added Field, "If they actually come to us [with a doctor's referral], they are doing it on their own will and really do want help."

Similar to Chase's program, the PTs in Hands of Hope can't guarantee patient compliance because many of the patients do not return. Yet some the patients will come back to visit and/or get more treatment.

SHE EXPLAINED that there was one case where a homeless man had broken both of his arms and came to PT after surgery for exercise programs. He continued to return on his own to let them know his progress. "We only saw him once for treatment but he kept stopping by and showing his progression to let us know how he was doing. It was really great to see how far he came."

Despite what many people believe, Field said, "A lot of the homeless people are well educated. Many know exactly who we are and what we do as PTs."

A native of suburban New Jersey, Field admitted the program helped give her a new outlook on the homeless. "Not being from Philadelphia, I always heard about the homeless, but never saw them. So I had this stereotype in my mind about them. But through working with them, I have realized that one minute they could be like us with a home and family, and the next day they could have a traumatic experience like they're house catches on fire or they lose their job. It multiplies all of their problems and they end up on the street."

When asked why she participated in the program, Field told ADVANCE, "What I did know about the homeless was that they didn't receive very much medical care, and when I heard about the Hands of Hope program, I thought it was a great opportunity to help."

Indeed it was. She stated that she has met "so many" wonderfully interesting people who she can help in various ways. "It's been extremely rewarding. Meeting these people and realizing that they're not just another face on the street and that they're just like me has been the most eye-opening," she added.

Not only did the experience have an impact on Field (and possibly every other PT student involved), but she said that the homeless patients benefited as well. She explained that most of the time the homeless have a difficult time trusting the medical community because of negative treatment they may have received in the past. "Getting them to trust us and realize that we do care, and that we're here for them--not for any other reason--has been a big part of the experience for all of us."

* For more information on Hands of Hope, contact Suzie Field, Edison Building, Room 830, Thomas Jefferson University, 130 S. 9th St., Philadelphia, PA 19107; e-mail: osorio1.jefflin.tju.edu; or visit the homepage: jeffline.tju.edu/C WIS/DEPT/PT/hands.html

Study Looks at Health of Homeless Men--PT May Help

While a third-year student at Thomas Jefferson University in 1995, Brigette Cuffia, MS, PT, who now works at Moss Rehab Hospital in Philadelphia, took part in a study about the health of homeless men. As part of her master's degree, she and two other students and two advisory faculty members conducted a pilot study, "A Comparison of the Perceived Health Status of Sheltered vs. Nonsheltered Homeless Men in Philadelphia," which was presented in poster format at the APTA Combined Sections Meeting in Atlanta this year.

The study examined 100 homeless men from Philadelphia, 50 of whom stayed in a shelter for two consecutive weeks or longer, and the other 50 who were nonsheltered for two consecutive weeks.

The researchers used the SF-36--a health status questionnaire that determines outcomes measures.

Cuffia said that the homeless men differed from the adult male norms in the following areas of the SF-36: role physical, bodily pain, general health, social functioning and role emotional. "This meant that the homeless men [in both sheltered and nonsheltered groups] reported worse health in all of the areas compared to adult male norms," the report explained.

While the research revealed little differences between the two groups of homeless men, it was determined that nonsheltered men were more likely to report emotional problems.

In addition to the SF-36, qualitative questions were given to both groups about pain and physical limitations. This part of the research disclosed that both homeless groups reported a high percentage of physical limitation and/or pain in the back and lower extremities.

The researchers concluded that there was a definite need for physical therapy in the population. "We found that we could address the areas that they were reporting health limitations in. And that there were certain aspects of a homeless person's lifestyle that could be addressed best by a physical therapist with exercise as a mode of treatment," said Cuffia, who also volunteers as a PT in the Hands-On for the Homeless program through the university (See story, above).

"As far as I know, it is the only research that was done on the potential of physical therapy intervention and the homeless," Cuffia said. "Since we have determined that there is a need for PT with this patient population, we feel our pilot study serves as a call for further research," she stated.

--Christine McLaughlin