No Barriers

Harborview and DESC team up to provide shelter — and a medical home.

When Stephen was homeless, he walked. A lot.

He walked from the St. Martin de Porres overnight shelter to the Lazarus Center or the Pike Market Senior Center — sites that would keep him out of the rain for a few hours. He’d walk to the pharmacy, where he could pick up his medications. Then, back to the shelter. Or, if there was no room there, he’d walk to one of several outdoor locations he hoped would be dry and safe.

On the day of his interview, Stephen, 66, was wearing sturdy walking shoes, even though he relies on his wheelchair. And even though — thanks to a housing site called the Estelle — he was given a place to live.

“I’m inside, and it’s comfortable, and I’ve got food, and I’ve got medical assistance,” he said, holding a traveler’s mug full of coffee. “I don’t have the constant struggle.”

Bringing services home
Opened in 2018 and located in Seattle’s Rainier Valley, the Estelle is a collaboration between the Downtown Emergency Service Center (DESC) and Harborview Medical Center. The 90-some residents are people who experienced homelessness. Some, like Stephen — confined to a wheelchair after a stroke and a series of falls — have chronic medical issues. Others have addictions and/or mental health challenges.

But all the residents, through the Estelle, have access to important services, including on-site medical care and in-house help to manage their needs (everything from help taking showers to getting Social Security payments). They also benefit from drop-in visits from various providers, including the DESC’s program for mental health.

And, crucially, they all have a home. The Estelle is part of a movement called permanent supportive housing. Meaning: truly permanent, and not a shelter.

Other types of housing assistance can be restrictive, explains Tricia Madden, Harborview’s director of downtown programs, ambulatory and allied care services. Before you apply, you have to get sober or be treated for mental illness.

“Many people are on the street for a long period of time…and some are never going to get clean and sober,” she said. “Let’s house people and bring the services to them.”

Lowering barriers
Permanent supportive housing like the Estelle offers an alternative, one that lowers the barriers to housing. It’s part of DESC’s ethos to meet people where they are — to remove the barriers and get them what they need. A similar no-barrier ethos plays out in the delivery of medical services at the Estelle.

Debbie Young, RN, a cheerful woman dressed in scrub pants and a sweatshirt, manages Harborview’s three-room clinic at the Estelle; the residents drop in, no appointments needed. She gives out bandages, changes wound dressings, makes medical appointments, helps residents get transport to the hospital and reminds people to take their insulin.

She’s also a comforting presence. “Sometimes residents just want to sit and talk,” she said.

The Estelle is not the only collaboration between UW Medicine and DESC. There’s also 1811 Eastlake, a site that provides permanent housing to formerly homeless people with chronic alcohol addiction, as well as a new supportive housing site in Rainier Valley. And the Estelle is not the only place where Harborview serves people experiencing homelessness in the Seattle area; there are multiple medical services downtown, including the Pioneer Square Clinic.

Still, the Estelle and its new sister site are special, helping people who have more complex medical needs with a wrap-around model of health and help.

“They pay attention to me,” said Stephen. “It’s good to have care.”

Feeling safe
When Stephen was homeless, he kept to himself. “That’s the safe thing to do. I never really trusted anybody,” he said.

At the Estelle, Stephen visits the TV room. He’ll watch CNN and talk politics. He has a few friends, and he developed a close bond with Olivia, the DESC staffer first assigned to help him. And Stephen likes Debbie Young — good news for the program, intended to increase residents’ trust in and engagement with the medical system.

He waited until Young was out of earshot, then delivered some quiet but deeply felt praise.

“She’s great,” Stephen said.

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