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The bouts of illness are growing more frequent, says Jim, upright in the navy-blue wingback chair next to his hospital bed.
They’re growing more severe, too, he says.
“Then, when I come out of hospital, I am either in a night shelter or I am on the streets,” says Jim, who asked that his surname be withheld because he feared upsetting his family.
As far back as 2014, government recognised this problem, and promised moves to address it. And yet, dozens of people are discharged every week into homelessness, says one doctor.
Some of Jim’s words are lost in the dull hum of a nebulizer. It drones on, under the clank of the mid-afternoon snack trolley and the squeaks of a wheelchair on the lino floor, and the distant blare of a daytime television show.
The most important thing in Jim’s life right now is his nebuliser – a green-tinted mask that covers his mouth and nose. His space mask, as he calls it.
A long clear tube runs from the mask to two cylindrical containers of oxygen, attached to the wall in the private room.
To use his own nebuliser, Jim needs a plug. It’s not a problem when he’s in hospital or within easy reach of a socket. It’s a different story when he’s left on the streets, unsure of where he’ll be staying that night.
This Thursday morning in mid-August, Jim, a former sales rep who has been homeless in Dublin for a decade, had been told he was being discharged, yet again, from St Michael’s Hospital in Dún Laoghaire.
A social worker had stopped in and said he’d be back to chat at lunchtime, says Jim. It’s now 2.00pm.
Being severely ill is stressful enough without being homeless too, he says. Where is he going to sleep that night? How will he get there? Will the bed be safe?
He leans forward in his seat, hands gripping the arms of the chair. “I’m so stressed, I’d fuckin shoot Bambi in the neck with a crossbow,” he says.
In and Out
Jim, who is 58 years old, was diagnosed with chronic obstructive pulmonary disease in 2007.
It’s in the last two years that the lung disease has really taken its toll, he says. It’s meant regular trips to the hospital. This is his fifth trip this year.
The day before he found himself at St Michael’s Hospital this time, he had spent the evening travelling up and down the Dart line, catching some sleep, knowing he didn’t have a bed for the night.
Sometimes you end up in Bray, says Jim. Sometimes, it’s Howth. On Sunday, it was Dún Laoghaire.
He huddled outside in a spot near the platform, trying to catch some rest but not sleeping. It’s not safe to sleep, he says.
At about 4.30am, he began to have real trouble breathing. There was nowhere to plug in his nebuliser. He had to wait it out until 7am when the town would begin to wake up and he could find a plug.
He got up, made to go, and fell against a railing, he says. A passerby called an ambulance.
In May, Jim’s lung collapsed. He got pneumonia. It took a couple of weeks in St James’ Hospital to recover, he says.
He slept in the Garden of Remembrance for several nights, and fell sick again, and went to the Mater Hospital. He was discharged into a hostel called Little Britain Street, operated by DePaul, he says.
“I spent nine nights there,” Jim says.
Inside is a dining room and a television room combined into one where residents would hang out, he says. “They were smoking in front of the TV, fuck everybody else.”
He had to be in there to eat. “It’s where the meals are given. They’re always smoking in there,” he says.
He complained to a senior manager, on repeat, for a week and a half, about one of the residents smoking inside, he says.
“He’s smoking a fuckin joint. I’m just trying to having my bowl of cornflakes,” says Jim.
The resident screamed at Jim that he was a rat, he says – and made a run at him.
DePaul haven’t yet replied to queries sent Tuesday morning about rules and residents smoking inside.
Jim packed his bags and left, and slept rough, he says. A couple of days later, he was back in hospital.
“I’m literally seeking safety,” says Jim. Homeless services aren’t giving him that, he says.
Instead, they’re stripping his dignity, he says – something he can’t tolerate. “It’s all I have left,” he says, leaning over in the chair, his voice quieter now.
“My health is gone, my money is gone, I’m dying, I’m homeless, I’m on the streets,” he says.
“All I have left is my fucking dignity and I will not live in a fuckin shithole full of fuckin needles,” he says. “And if I die in an alleyway so fuckin be it. I’m steaming mad.”
Discharge from Hospital
Between 20 to 25 people are being discharged into homelessness every week from St James’s Hospital, says Dr Clíona Ní Cheallaigh, clinical lead of the Inclusion Health Service.
In 2014, Minister for the Environment, Community and Local Government Alan Kelly, and Minister of State Paudie Coffey said they would put in place a formal discharge protocol so that “as far as possible, no patient will be discharged into homelessness”.
A draft protocol was produced in 2017, which went out for feedback and review, said a Health Service Executive (HSE) response to a Freedom of Information Act request in March this year. After that, an oversight committee was set up to “lead the review, implementation, and evaluation” of a protocol, it says.
A spokesperson for the HSE said this week that the Homeless Hospital Discharge Pilot Project is due to commence later this year. Working groups were set up to decide objectives, and what they should track to see how it’s working.
The HSE’s National Social Inclusion Office has funded a 12-bed residential unit since September 2018, they also said. Operated by Dublin Simon and Safetynet, it “provides short-term semi-acute healthcare […] interventions, treatments, investigations and observations for people without homes who fit the eligibility criteria,” they said.
The Inclusion Health Teams – set up to focus on supporting those who are homeless, to make them feel more comfortable in hospitals – have been a great success, says Ní Cheallaigh. The programme is being rolled out in the Mater Hospital and hopefully others nationwide, she says.
“So we see them, we assess what their needs are, we give them a lot of psychological support because it can be really tough being in hospital,” says Ní Cheallaigh.
But doctors and healthcare workers are limited in what they can get for those who are discharged, she says.
It mostly depends on where patients were staying before. If they’re coming in from hostels that have a long-term bed, they often end up back there, says Ní Cheallaigh.
If patients come in from short-term homeless emergency accommodation or the streets or a tent in the park, then healthcare staff pass the information on to Central Placement Services – the hub where Dublin Region Homeless Executive (DRHE) assigns people presenting as homeless to accommodation – about how sick they are, says Ní Cheallaigh.
“We can always get a bed for the night of discharge but that is often a bed for that one night in an emergency hostel,” she says.
Sometimes people come into the hospital housed and leave homeless, says Ní Cheallaigh – a situation facing a sick patient at the moment, whose wife has just died while he’s been in hospital, and who just lost his private-rental apartment, too.
“Now he’s facing homelessness for the first time after leaving hospital,” says Ní Cheallaigh.
The solution, she says, is twofold: more social housing first, then more supported accommodation.
A spokesperson for DRHE says that they have a hospital discharge liaison officer who makes sure that hospitals and DRHE work closely together when homeless people are discharged from hospital and into emergency accommodation.
“In relation to the numbers, I can tell you that in July there were two hospital discharges to homeless services,” said the spokesperson.
Looking for Dignity
From his hospital bed, Jim contemplates his options. Return and rest for a few days in his family home, where he shields his mother from the knowledge he is homeless. Wait it out and see what news the social worker brings.
When he was discharged from hospital once last year, they told him they were going to bring him somewhere nice to stay, he says.
“They brought me to the feckin Brú. The Brú,” says Jim, repeating the name of the Thomas Street hostel. There was blood all over the place, he says. Needles in the bathroom.
He walked out at 7am, as soon as the doors opened.
“I’ve given up now. I tell you something else as well,” he says. “I’m coming to a point where I’m spending so much time in hospital that I’m actually embarrassed.”
Why? Every few weeks he’s back in hospital, he says. “I’m frightened I’d bore the shit out of everyone.”
“I’m getting really embarrassed about this. And that’s another reason I don’t go into Parkgate” – DRHE’s headquarters – “because I’m actually embarrassed pleading with these bastards to help me.”
Shortly before 3pm, a young social worker walks into the room, followed by a nurse, clipboard in hand. They haven’t had any luck finding him a suitable bed for the night in homeless services, they say.
The good news, though, is that he can stay the night, see what the next day brings.
Jim perks up as he parks the stress of the system, for a small while at least. “Once they’re happy I’m not taking a bed from someone, I’m happy,” he says.
After two weeks in St Michael’s Hospital, Jim was offered a bed back at the hostel on Little Britain Street. He refused it because of his previous experiences there.
[UPDATE: This article was updated on 21 August at 12:25 to include responses from the HSE spokesperson.]