Jane (not her real name) walked into my office smiling, something I had never seen her do in the 18 months she had been coming to one of my hospital’s primary care clinics. “I have a home,” she almost shouted as she reached out to hug me.
Jane’s news was the happy conclusion of an extended and worrisome waiting period; her lack of stable housing had been taking a toll on her health and well-being.
When I first met Jane, she had high blood pressure, for which I prescribed some medicine. At that time, she and her teenage son were living with her boyfriend, who was physically and verbally abusive. Jane told me several times that she “needed to get out” because she didn’t feel safe in his home. But with nowhere else to go, she stayed.
“Have you thought about staying in a shelter?” I asked.
“No,” she said. Her son had asthma, and she worried that shelters had dust and mites, which would make his asthma worse. She had applied for public housing months ago, but hadn’t gotten any responses.
When I saw Jane a few months later, her boyfriend had kicked her out of his apartment and she was staying with friends in a neighboring state. She had taken a train and a bus to get to her appointment with me.
Her blood pressure reading that day was dangerously high, 225/129 (a “normal” blood pressure reading is 120/80 or lower), and she had lost weight. I told Jane I was worried and recommended she go to the emergency room for further evaluation. She declined. She needed to catch the train back and get home — or at least the place she was momentarily calling home — to care for her son. I prescribed a second blood pressure-lowering medication, knowing that I was treating a symptom rather than the core of her problem.
Doctors often have a different set of priorities than their patients. We are naïve to think we can adequately address chronic diseases when our patients’ physiological needs, such as shelter, aren’t being met. My medical training hadn’t prepared me to solve problems like this. Although Jane and I met with our clinic’s social worker after each visit, and I continued to scour community programs, her living situation remained precarious.
Housing stability and health are strongly intertwined. Jane had applied for the Section 8 housing choice voucher program, a federal program that helps low-income families find decent and safe housing in the private market. Unfortunately, the number of vouchers are limited and wait lists can be long. Up to three of four applicants for federal rental assistance don’t get vouchers. And some individuals who do get them still can’t afford their rent since they are responsible for contributing up to one-third of their income for rent.
When I saw Jane again, she was depressed and withdrawn. She was drowning in her clothes as she continued to lose weight. I asked if she had thought about killing herself. She told me, “Death would be easier. At least then I would have a place to live.”
I called the public housing authority on Jane’s behalf multiple times, and was shunted off to endless voicemails. I was not optimistic she would get housing assistance. In fact, I felt hopeless.
Fortunately, Jane finally got good news. She had served her time on the Section 8 waiting list and moved into a new apartment. She felt safe in her new neighborhood and was taking daily walks. She also had a new job. Her mood was improving and she had even gained back the weight that she lost. And since she wasn’t allowed to smoke in or around her building, she had quit smoking.
When low-income individuals get stable housing, their stress usually goes down and their health improves. It’s easier for people like Jane to go to follow-up appointments without worrying about where she will be sleeping that night. She has a place to store her medications and can now spend her time and effort making healthier food choices or exercising. Stable housing allows victims of domestic violence to find a safe haven and improve their mental health. It also reduces overall health care expenditures by contributing to an increase in the use of primary care services and a decrease in emergency department visits.
As I hugged Jane, I looked forward to the adventures and accomplishments that now await her and her son — but worried about all the other Janes who don’t have safe, stable places to live.
Ersilia M. DeFilippis, M.D., is a third-year resident in internal medicine at Brigham and Women’s Hospital in Boston. The views expressed here are her own and do not necessarily reflect those of her employer.
