January 10, 2023 – Zasitalia Ferro doesn’t want anyone to die alone.
Having worked as a nurse for more than 30 years—12 of them as a hospice nurse—Taliaferro has always felt at ease around the sick and dying.
What bothers her is the number of her patients who die without the comfort of family or friends.
“We see people in their 80s or 90s without families. We see veterans, the homeless, the forgotten vulnerable,” says Advanced Nursing + Home Support, a Rockville, Maryland-based home health company. Taliaferro, assistant director of nursing, said. “We’ve been out there with people who didn’t have one, and that went straight to my heart.”
Taliaferro is opening a home for the homeless and chronically underserved in her community of Montgomery County, Maryland, outside Washington, D.C., which has one of the highest incomes Percentage of poor residents in the country. Every night, more than 4,410 people are homeless in the country’s capital.
“No one should die alone unless they choose to,” Tagliaferro said. “I believe that anyone, regardless of age, wealth or background, deserves the utmost integrity, grace, compassion and love.”
The growing need for hospice homes
As baby boomers age, there will not be enough family caregivers to take on the task of providing this care. AARP Policy Institute estimates By 2030, there will be four potential family caregivers for every person over the age of 80. That compares with a 7-to-1 ratio in 2010. By 2050, those numbers will drop to three to one.
Of course, the homeless population is also aging. A 2019 report Projections from the University of Pennsylvania show that the number of homeless people 65 and older in the United States will nearly triple over the next seven years, from 40,000 in 2017 to 106,000 in 2030.
Homeless Americans are aging prematurely, the result of chronic stress associated with living in shelters, the streets, and couchsurfing. This phenomenon is called “weathering,” and it’s an area of particular interest to Rebecca Brown, MD, MPH, a gerontologist and assistant professor of medicine at the University of Pennsylvania in Philadelphia.
Brown’s study found that homeless people aged 50 and over had a median age of 80.
“They get these aging-related diseases at a young age, and then, not surprisingly, they also die earlier,” Brown said.
Many people with terminal illnesses such as cancer will spend as long as possible caring for themselves in homeless shelters, said Travis Baggett, M.D., director of research for the Boston Homeless Health Care Program.
“But once they can’t get up on their own or shower themselves or need oxygen (which most shelters don’t allow), they can’t stay there anymore,” Baggett said.
These individuals may end up cycling between hospitals or nursing homes, where they receive medical care until death.
Taliaferro has been working with professional photographer and hospice midwife Emily Cavey. Like a labor doula, Cavey provides mental, emotional and physical support to the dying and their families. After Taliaferro coordinated care for Cavey’s dying loved ones through her work, the two bonded and discovered they shared a similar desire to help people in their final stages of life.
Taliaferro told Cavey her idea was to build a home where the underserved and formerly homeless could die with dignity, and they eventually formed the nonprofit Good Hearts Foundation to raise money for their cause.
They are still in the early stages of finding potential donors for suitable homes for the operation, as well as other sources of funding, such as grants, to build and operate the homes.
At this time, it’s unclear how the homes will be licensed or licensed. Taliaferro and Cavey are also looking at what kind of license they need to operate a residence; Maryland county officials initially thought the couple needed a hospice provider license. But the family itself will not provide medical care. Residents will be able to bring in outside health care providers to provide services, but there will be no financial ties between residential facilities and these companies.
They already have a name for their first home: Maddie’s House, named after Taliaferro’s mother, who died in a car accident when Taliaferro was 2 years old. They hope to open in 2023.
Grace House: A Model Nursing Home for the Homeless
Taliaferro’s interest in Maddie’s House was sparked after she learned about Omega Home Network, a membership of 40 homes and others under development, all of which serve the same purpose of providing housing for those in the last People who live alone for a few days provide a loving environment.
Grace House, a nursing home in Akron, Ohio and part of the network, opens in September 2022 for the terminally ill.
Funded by grants and donations, the facility has three requirements for residents: they must be enrolled in a hospice program through Medicare, Medicaid or a private insurance company; their financial resources must be limited; and they cannot find someone who can house and care for them. All services are free to residents.
Holly Klein, RN and founder of Grace House, regularly cared for homeless patients during her 14 years as a home hospice nurse in Akron.
“I use the word ‘home’ liberally because it’s literally where the patient lives,” she said. “I’ve met people under bridges, in motel rooms, in homeless shelters, some in undignified living conditions. It was a burden to see people dying alone in that situation, and I started asking questions like this.” A question, ‘Shouldn’t we be doing more?'”
Hospice providers with no financial ties to Grace House regularly visit individual residents as if they had their own private residence to manage clinical care, while the home’s staff assists residents with cooking, cleaning, personal care 24/7 and medication.
“We consider ourselves a surrogate family,” Klein added. “Anything a hospice program can teach a family to do at home, they can teach our staff to do, like simple dressing changes and medication education.”
Since it opened, 16 residents with terminal illnesses, including heart and kidney disease, have come to Grace House to live and die within its walls.
Five residents had experienced homelessness prior to their arrival, several from homes that “really collapsed or had no running water, electricity or heat,” Klein said.
Residents who have lived alone at Grace House for years may enter the facility with isolation and caution. But many forged friendships with each other, staff and volunteers — and even reconnected with estranged relatives in their final days and weeks.
“We provide an environment where they feel safe and secure, which allows them to let go of some of the barriers and old habits and reconnect with people,” Klein said. “It was amazing to see it.”
