HLOL Podcast Transcripts

Health Literacy

Health Literacy and People Who Are Homeless (HLOL #184)

Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and your host of Health Literacy Out Loud. In these podcasts, you get to listen in on my conversations about health literacy with some pretty amazing people.

Today, I’m talking with Samantha Wood, who devotes herself to serving those who are the most vulnerable and helping them fulfill their life goals.

Samantha is Senior Housing Stabilization Case Manager at The Haven, which is a multi-resource day shelter for people who are homeless. The Haven is located in downtown Charlottesville, Virginia. Samantha takes pride in serving the area near where she grew up.

I met Samantha at a health literacy workshop I was leading for the Regional Library System in Charlottesville. She and I chatted briefly during a break about her work with people who are homeless and my focus on health literacy. I knew right away that this was an important topic to talk about together.

As a companion to this podcast conversation, here’s another resource about communicating with people of all backgrounds and abilities.

In my book Health Literacy from A to Z: Practical Ways to Communicate Your Health Message, there are seven chapters on knowing your audience. Topics include issues of literacy, language, culture, emotions, cognition, vision loss, hearing loss and communicating with older adults, children and youth. Look for the version updated in 2018, available in print and as an ebook on Amazon and iBooks.

Here’s my interview with Samantha Wood.

Welcome to Health Literacy Out Loud, Samantha.

Samantha Wood: Thank you so much for having me this morning, Helen.

Helen Osborne: Being homeless, I’ve never done a podcast on that topic. As soon as you said that was the work you do, I knew I needed to focus on it. Please describe for me and all our listeners what it’s like to be homeless.

Samantha Wood: Being homeless is not a fun experience by any means. It’s highly stressful and traumatic. You are constantly worrying about survival, where to eat, where to sleep, how to get clothing on your back, and safety.

There are just so many concerns that you have to worry about every day. It’s just very tough, not just physically but also mentally as well. It’s not a life that a lot of people can handle, really.

Helen Osborne: What causes people to be in this situation?

Samantha Wood: There are many different causes. What I’ve seen in my work at The Haven is the fact that people have a lack of human relationships, which is what causes their homelessness.

For some folks, if you lose your job or if you have a major health crisis, usually there’s someone like family or friends you can turn to, even if you do lose your own housing, so that you don’t end up literally living on the street.

For our folks, they have no one in their lives as a backup plan, so they end up homeless.

I’d say that the number one reason for homelessness is just lack of having a social network, lack of having human relationships that you can fall back on in dire need.

Helen Osborne: It might have been that someone used to have those relationships and no longer does?

Samantha Wood: True. It could be that, due to mental illness or substance abuse illness that has been untreated or undiagnosed, they could burn bridges with family members or friends. It could just be other factors where maybe they live on opposite coasts and it’s just harder for them to connect.

Helen Osborne: Some crisis happened and now a person has nowhere to live.

Samantha Wood: Right.

Helen Osborne: Can you describe what The Haven does and how they help?

Samantha Wood: The Haven has been around in Charlottesville, Virginia, for eight years now. It was founded in 2010 by Tom Shadyac, who’s the director of “Evan Almighty” and “Bruce Almighty.” He’s a UVA alum who came in town and filmed one of the movies here.

He realized there were a lot of homeless folks living in Charlottesville. Charlottesville is very prosperous town. We have a lot of multimillionaires and wealthy folks.

He was disturbed by this and met with many community leaders and advocates, and was able to get First Christian Church here on the Downtown Mall. He was able to purchase that, so we moved in. We’ve been running since 2010.

What we do is we’re a day shelter.

Helen Osborne: What does that mean, a day shelter? When I think of homeless, I think about overnight.

Samantha Wood: For us, we’re open usually from 7:00 a.m. to noon. People come in and they do their laundry. They can get a hot breakfast. Usually, it’s very healthy. We provide personal care products for folks.

We also provide a place where they can rest, a quiet place, if they’re not able to sleep. Honestly, sleep is very hard to do if you’re outside.

We partner with a thermal shelter called PACEM. They’re the ones that actually house folks at night. They house folks at night and then folks come here in the morning.

Then in the afternoon, they usually go to the soup kitchen for lunch or they go to the library. A lot of homeless folks hang out in libraries.

Helen Osborne: Interesting.

Samantha Wood: They’re kind of the unofficial shelters for the homeless. A lot of big urban areas have social workers in their libraries because so many homeless folks go there during the day. There are really not too many other places you can go to stay warm or cool, depending on the season.

Helen Osborne: It sounds like this is a great patchwork quilt of services that happens over the course of a day and evening. But it’s still not a pleasant situation for anyone to be in.

You talked about issues of substance use. You talked about mental health. When you and I were talking about health literacy, you talked about that intersection of health and people who are homeless. What are some of the issues that might crop up? I want to hear about those. Share some stories, please.

Samantha Wood: For folks experiencing homelessness, it can be a very emotional time in their life because there’s a lot of uncertainty. They’re having to structure their day schedule based on survival.

That also weighs physically, too. There’s a statistic that if you’re homeless and you’re in your 50s, you have the same or similar health issues as an 80-year-old.

Helen Osborne: Oh my goodness.

Samantha Wood: Yes, it weighs that much on your body.

Helen Osborne: Being homeless itself, just being in that situation, can lead to health problems, correct?

Samantha Wood: Correct. It can age you drastically, faster than the general population.

Helen Osborne: Also, can health problems lead to being homeless?

Samantha Wood: Correct. I have met several individuals here at The Haven who used to work full time, made a lot of money, big house, cars and they were self-employed, or owned their own business.

If someone is in roofing or any physical labor type of sector and they fall off a roof and break their back, they can’t go back to work. Then you can’t pay your mortgage payments and car payments. You can see how you end up losing everything that you once had.

You could have a major health crisis or a car accident, something like that, something that was obviously not planned, a sudden crisis.

Helen Osborne: Then what about the issue of chronic disease, too, which is so prevalent in our society? You cited an example of someone who’s 50 whose body is acting like he or she is 80. What’s the role of chronic disease and all those other diseases people get?

Samantha Wood: We see a lot of heart disease, cancer and diabetes, but at younger ages than the general population. Someone who’s 40, if you look at his medical record, looks like he’s 70, depending on his ailment.

Folks usually have multiple issues going on at once. It’s hard for them manage all those diagnoses and also be living on the street.

For example, if you have a diagnosis of diabetes and if you eat at soup kitchens, soup kitchens have a very limited budget. They can’t use a lot of high-end vegetables and fruit. They try their best, but sometimes it’s spaghetti, which is a lot of carbs for a diabetic.

But that’s the only food option you have for that day. It’s not like you can run out and get a salad somewhere or something that has less sugar or carbs in it because you can’t afford to eat anywhere else. This is your meal for the day. It’s hard to take insulin when you’re camping outside.

Helen Osborne: Oh my goodness. Thank you for making that more real.

In the workshop and all the workshops I do, and for all of us who are interested in health literacy, I’ve got tips, strategies, best practices, and ideas for professionals on how to communicate health information more clearly.

When you and I were chatting at the coffee break at that workshop, you said, “Wait, this might be really hard for someone who is homeless.” I was very humbled by your comment.

How can those of us who care so much about communicating health and making a difference help folks who are homeless and also have medical issues?

Samantha Wood: Here in Charlottesville, we have University of Virginia Medical Center, which is a huge place, Trauma 1 hospital and recognized nationally as a great hospital.

We also have another hospital called Martha Jefferson Hospital. They’re a smaller, private hospital, but also do amazing work. We have a bunch of different individual clinics throughout the area.

I would say that access to medical care is not the issue. It’s getting to those places, not physically but being able to mentally handle walking through those clinic doors.

Helen Osborne: Really?

Samantha Wood: A lot of our folks fear going to the doctor. Usually, when you go to the doctor you hear bad news. They’re worried about not understanding what the doctor is telling them. That makes them feel stupid and inadequate, and they’re already judged every day.

Helen Osborne: The folks you are working with can somehow get needed health services, but some of these folks are just saying, “I’m not doing that”?

Samantha Wood: Right. The main reason is fear. It can be very scary for someone. Even for me, when I go to the doctor, it can be scary, especially if I have to go to a specialist. I don’t even know sometimes what my doctor is saying and I really have to ask a lot of questions.

For a lot of the guests here at The Haven, they are fearful of having to have a conversation with a doctor and don’t want the doctor to judge them, especially if they can’t comply with whatever their treatment plan may be, such as the newly diagnosed diabetic who needs to take insulin now and has to eat so many carbs per day. There’s no way that person could comply. It’s nearly impossible being homeless.

Then there’s the worry that if they go back and their doctor says, “Your blood sugar levels are still really high. What’s going on?” they’ll be judged. That’s a lot of the feedback that I get.

Helen Osborne: It magnifies all those concerns that are so common for so many people.

Samantha Wood: Right.

Helen Osborne: It’s your turn, Samantha. Tell us, inform all of us about how those of us in healthcare can do a better job. How can we be respectful and inclusive and genuinely help those, for whatever circumstances, are homeless right now?

Samantha Wood: Actually, in your state of Massachusetts, in Boston at the Mass General Hospital, about a decade or so ago, there was a group of doctors who decided that they wanted to help the folks they were seeing who were homeless try to increase their life expectancy and health outcomes.

They were noticing that folks who were homeless were dying more often when they went to the hospital. But also, if they needed surgery, they had nowhere to stay post-surgery. There weren’t enough hospital beds.

Helen Osborne: Of course.

Samantha Wood: We see that here, too. Folks need surgery, but they have to postpone it because they have nowhere to stay after their surgery and the hospitals don’t have the bed space.

A group of doctors said, “This isn’t good. We need to do something about this.” They were able to convince the hospital to build more bed space so that the homeless could have a respite place where they could go if they needed surgery.

They also established a mobile clinic where they would go out and do outreach. They’d have a social worker, a psychologist, a doctor, a nurse and usually a nutritionist.

They would go and meet folks sleeping outside. They’d go to campsites, and they still do this to this day, and try to help people maintain whatever chronic disease they may have mentally and physically.

It’s been very successful and they continue to do that. That’s a model that I think works well.

Helen Osborne: We’ve got listeners from all across the country and all around the world. I’m gathering from your message that it’s really working on perhaps setting up some systems. Perhaps we as health professionals might go out to the community rather than waiting for community members to come to us. Is that correct?

Samantha Wood: That’s correct. That way, people feel comfortable because they’re in an environment where they feel safe and secure and not judged.

The doctors realized that 80% of what they do in the clinic office can be done outside. I didn’t even realize that.

Helen Osborne: I didn’t realize that either.

Samantha Wood: They meet people in malls, in their campsites or at homeless shelters, wherever that person feels most comfortable, and people are more receptive. They’re more able to meet with doctors or a mental health professional because they’re coming to them versus having to come to a place that’s very scary.

Helen Osborne: Of course.

Samantha Wood: If you walk into a doctor’s office, sometimes you see that glass door that separates you from the receptionist, and already you get this cold feeling of, “Oh, man, I don’t really feel comfortable here.”

Helen Osborne: You’re talking a lot about the environment, the services, and that feeling of being afraid. What about those of us who do not have influence at that level? What can we do to make it just a little bit better as we are meeting in person with someone who is homeless?

We might be the direct caregiver right then, or perhaps over the phone. Whatever encounter we might have, what are tips we could do to make it a bit better at that moment?

Samantha Wood: I think it’s just being compassionate and a good listener. Folks experiencing homelessness unfortunately are not treated very well in our society. There’s a lot of stigma attached to being homeless.

Just to have a friendly face, someone that even just says hi. Or if they are on the phone, someone that has a friendly demeanor and will listen to whatever problem they have. That goes a long way.

The human connection/relationship goes a long way. I’ve learned that in my work here that nothing else matters if someone doesn’t trust you and doesn’t feel like you have their self-interest at heart. They will not follow through with anything if they don’t feel like you truly, genuinely care.

The takeaway is just having that connection. It can be small, so, like I said, just saying hello. If you are a doctor or provider, just take the time to listen to your patient and realize how tough it is to be homeless. It’s not as easy as just being able to pop a pill and everything will work out.

Helen Osborne: Thank you. I hear that compassion. I felt it when I was in your physical presence and I hear it as we’re recording this now.

Samantha Wood: Thank you.

Helen Osborne: We all should have a bit of Samantha in what we do.

I want to get back to that very real example. Let’s say we are the person talking with someone who is newly diagnosed with diabetes, but that person cannot make the food choices we are recommending. What do you do recommend we do as professionals in that situation?

Samantha Wood: I think the best thing to do is just realize that there are restrictions as far as food and what the individual can eat. Maybe suggest smaller portions or some kind of innovative way to make that meal less harmful for their blood sugar level. Also, understand that maybe their sugar levels will be high for a while because they’re homeless.

Advocating for housing would be great. There are statistics that show that once someone is housed, they do a lot better than if they’re unhoused. It reduces the cost of hospitalizations by 77% if someone is housed.

Helen Osborne: Wow.

Samantha Wood: It reduces healthcare costs all around by 59%, so advocating for housing would be essential, as well as making sure you understand where your patient is coming from. They may not be able to comply right now, but maybe be innovative and think about ways they can be healthier, like promoting more exercise to offset the nutritional limits.

Helen Osborne: It’s really bringing in our great skills as human beings and being creative.

I have another question, and it might be naïve. Is it okay to ask someone what it’s like to be homeless? Are they going to tell us that they’re homeless? Is that an okay thing to talk about?

Samantha Wood: I think it should be part of any generic questionnaire in any doctor’s office.

Helen Osborne: Is there certain wording? I just heard you say something about someone who is unhoused. Is there certain wording we need to use or not use?

Samantha Wood: People experiencing homelessness, living with homelessness, unhoused versus the concept of homeless. I think just saying “homeless” can have a stigmatizing effect.

I don’t see any problem with understanding someone’s living situation. If you understand someone’s living situation, you can diagnose and treat more effectively.

I think education is key. Asking someone who is homeless what that’s like so you know what their day-to-day is and you can walk that journey with them speaks volumes of your ability to connect with that individual.

Helen Osborne: Thank you. Maybe that’s where our worlds intersect at such a profound level–understanding and having compassion for the other person we are working with. Together, we do walk down that path toward better health and better health understanding.

Samantha, I thank you most sincerely for all that you do. You have taught me so much. I hope our listeners have learned a lot, too. I expect that they have. Thank you so much for being a guest on Health Literacy Out Loud.

Samantha Wood: Thank you, Helen, so much for this opportunity. I really am excited and thrilled to help educate people on the intersection of health and homelessness for sure.

Helen Osborne: Thank you.

Samantha Wood: Thank you so much.

Helen Osborne: As we just heard from Samantha Wood, it’s important to communicate respectfully and understandably with everybody when we talk about health. But that’s sometimes extra hard to do.

For help clearly communicating your health message, please visit my Health Literacy Consulting website at www.HealthLiteracy.com. While you’re there, feel free to sign up for the free monthly e-newsletter, What’s New in Health Literacy Consulting.

New Health Literacy Out Loudpodcasts come out every few weeks. Subscribe for free to hear them all. You can find us on iTunes, Stitcher Radio, Google Play and the Health Literacy Out Loudwebsite, www.HealthLiteracyOutLoud.org.

Did you like this podcast? Did you learn something new? I sure did and hope you did, too. If so, tell your colleagues and tell your friends. Together, let’s tell the whole world why health literacy matters.

Until next time, I’m Helen Osborne.

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"As an instructional designer in the Biotech industry, I find Health Literacy Out Loud podcasts extremely valuable! With such a conversational flow, I feel involved in the conversation of each episode. My favorites are about education, education technology, and instruction design as they connect to health literacy. The other episodes, however, do not disappoint. Each presents engaging and new material, diverse perspectives, and relatable stories to the life and work of health professionals.“

James Aird, M.Ed.
Instructional Designer