By Nancy Redwine, a Lifebridge client
Content warning: This essay contains descriptions of suicide ideation.
Happy to be here.
Happy to be writing to you in my new apartment, a week after my 61st birthday.
On my 60th birthday I asked my daughter, who I was living with at the time, to drop me off at the hospital. I no longer wanted to do this – ‘this’ meaning dealing with life. I was so tired, so frustrated, so depressed and so angry, oh, so angry.
I knew the ER routine by heart, not because I had done it before but because I used to work in the medical field. It goes like this: get medically cleared, then evaluated by crisis personnel, then asked: do you have a plan?
Yeah, I had a plan: I didn’t want to do ‘this’ anymore.
I stayed for a week and five days at the hospital when I lost my health insurance (oh, yay). “You must release me,” I said. “I have no means to pay for my care.”
“We can’t,” I was told, “unless you have a place to go.”
Catch-22. I didn’t. I couldn’t go back to my daughter’s; I didn’t want to be a burden any longer. Hospital staff assisted in helping me get insurance and finding a Community Crisis Stabilization unit (CCS).
Catch-22. Unless you have a dual diagnosis, finding in-patient, long-term mental health care is next to impossible.
My only option: becoming a homeless person. My age group, I learned, the 50 plus folks, is one of the fastest-growing homeless populations. Geez, we even had a nickname: the ‘Gray Wave’, or –- my favorite –- the ‘Silver Tsunami’.
I had a decision to make: Where to be a homeless person.
I had spent the majority of my life on the North Shore, in Salem for over 40 years and in Lynn for almost 10. I considered it my safe place, or at least a comforting place. Off I went (Thank you, Montachutt Regional Transit Authority, or “MART” for short).
At Haymarket Square in Boston, I spent a night, not truly sleeping as I was at a bus stop, then made my way up to Lynn. All three of my bags clutched tight, I spent the day on Central Square, just breathing. Then, ever the practical person, I realized: Well, darn, while armed with phone numbers for various shelters and food banks, I would also need a bathroom and I would need drinkable water.
Finally, I did think of a safe-ish spot to go, bathroom and water included: Lynn beach. I truly learned great lessons, some sad, some wonderful. I met kind people, and some of the other kind: those who shared their food, water, and coffee; others willing to share drugs, liquor, and cigarettes. I accepted food, water, coffee, and the occasional cigarette. Feeling so bleak, and morbid, so lost in being stuck, I realized it was the kindness of these strangers that pulled me through. They gave me the hope and determination to move forward. One of them, a Nancy like me, not only gave me food but rides in my search for a safer place. One of those rides took me to River House, an all-female shelter of Lifebridge North Shore.
At River House I took steps to regain my life. I received guidance on how to apply for food and money assistance, for an ID, and for housing. It took 9 months, and a lot of hurry up and wait. While waiting, I worked on my issues through individual therapy, group therapy, in house and at health facilities, and through my own soul searching.
Happy to be here, writing to you from my own apartment. Yeah, what a chaotic year it has been, what a worthwhile year. I am so happy to be here, so happy.
Discussion: Health Insurance, Mental Health Needs, & Attaining Documentation While Homeless
By Helen Wurthmann, Lifebridge associate director of communications
Nancy’s story is just one example of the time and dedication it takes to attain health insurance, food, income, and housing, even after finding emergency shelter. Understanding these issues more broadly — and their solutions — can empower our community to support those struggling to get their basic needs met.
Nancy’s essay begins with a hospital admission to protect herself from suicidal thoughts, but losing her health insurance puts her in a difficult position. Her struggle with mental health is one many of us can relate to; one in five adults in the United States report mental illness each year. However, 52% of Lifebridge clients identify as having a mental health disorder, making attaining support a key step in our efforts to support vulnerable neighbors.
There are several reasons someone might lose their health insurance while they're receiving treatment at a hospital. “For instance, someone may not receive notices to provide verifying information before a specific due date,” explains Carina Pacheco, a Lifebridge program director. “Things like not having access to a mailing address or not having a phone available are also a huge factor.”
Nancy received assistance from hospital staff in attaining health insurance, but this help is not guaranteed, especially without “core documents” like an ID, birth certificate, or social security card.
Registering for health insurance — even MassHealth (Medicaid) — can be difficult if you don’t have these required documents. “Case managers at Lifebridge help advocate for clients on calls to get insurance activated temporarily if they don’t have their core documents, and we’re given a due date for when we’d need those documents to keep the insurance active,” Pacheco adds. IDs, social security cards, and copies of birth certificates cost money and may require a permanent address to receive them; Lifebridge staff assists with both of these hurdles. “Case managers request funds from our finance department, made possible through donations by our community,” Pacheco says. “And clients can use our day centers or shelters as their permanent address.”
Once someone has acquired insurance, what happens to the bills they received while they were uninsured? Not being able to pay for past care can perpetuate the cycle of homelessness. Therefore, addressing medical debt is a good first step. “Within a specific amount of time between receiving care and attaining insurance, case managers can also help retroactively appeal hospital bills if you can show that you were homeless and didn’t have a source of income when you received care,” says Yari Acevedo, River House program director. While it’s not guaranteed that Medicare will cover costs retroactively, this step can help start the process of addressing medical debt.
Support doesn’t stop at attaining insurance. One of the most important habits in managing mental health disorders is on-going treatment. Community health centers that take MassHealth are a good place to start, and Lifebridge’s Salem Campus hosts the Salem Family Health Center every Wednesday and Thursday. These partnerships with other community organizations allows Lifebridge clients to more easily access referrals and telehealth appointments.
Even once a client has achieved housing, Lifebridge case managers continue on-going support. These check-ins help keep clients housed during a difficult life transition.