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Courtesy Fourth Street Clinic
Hospice care for the homeless is challenging because, according to one care-giver, "Everything is extended out to the extreme when you're dealing with this population." The Fourth Street Clinic is attempting to create a hospice for the homeless. It's a collaborative effort to care better for homeless people near the end of their lives.

For Kristy Chambers, chief executive officer of Salt Lake City’s Fourth Street Clinic, the memory is still troubling — and motivating.

“We had a gentleman who came to us who was in the latter stages of his life,” she said softly, her upbeat demeanor noticeably shifting at the memory. “He knew he was dying, and he seemed to be at peace with it.”

The clinic, located on the southwest corner of 400 South and 400 West, exists to provide a wide variety of medical services to Salt Lake City’s growing homeless population. Its effectiveness and capability are the envy of other homeless service providers around the country, and the full resources of the facility were employed on behalf of the man Chambers was talking about.

“We did the best we could to care for him,” she said. “We even tried to help him reconnect with his family. That’s what he needed at this point in his life, but that didn’t happen.”

That isn’t unusual among the chronically homeless, she observed. Often family ties have been so severely severed that there is no reconnection to be made.

“He reached the point where he was close to the end, and what he needed was hospice care,” she said. “But he had no insurance, and he wasn’t covered by Medicaid, and he had no family. He died in a hospital emergency room — alone, in that sterile environment, without any love or peace or dignity.”

Chambers paused for a moment, then looked up.

“Nobody should die alone like that,” she said. “These folks deal with enough indignity in their lives. They should at least be allowed to die with some degree of dignity. But everything is extended out to the extreme when you’re dealing with our homeless individuals.”

That will soon change, if Deborah Thorpe has anything to say about it. Thorpe is an advance practice nurse at the Huntsman Cancer Institute and is experienced in end-of-life care. As a volunteer she has been working closely with Chambers and her staff as well as the Salt Lake City interfaith community to create a much-needed hospice for the homeless that will eventually include a home and surrogate families to surround dying residents with love, faith and dignity.

“We call it the Inn Between,” Thorpe said. “It will be for those who fall in between the cracks of the health care system.”

It will also be a place where people of faith can come to serve — which is exactly how the idea of a hospice for the homeless got started in the first place.

“I was working one Saturday at the food bank at St. Paul’s Episcopal Church,” Thorpe said. “We see a lot of sad situations among the people who come to the food bank, including some who are clearly getting close to the end of their lives. Some of us who were working there that Saturday started worrying: What happens to these people? Who is there for them?

“Taking care of people at the end of life is part of my profession,” Thorpe continued. “But I know that hospice care costs money, and it relies on the cooperative efforts of medical professionals, hospice care providers and family and friends. Usually it happens in the home. But what happens when you are homeless, and you have no money, no insurance, no family, no friends?”

Eventually Thorpe brought her concerns initially to the now retired Fourth Street Clinic Founder, Allan Ainsworth, whose staff was already wrestling with the problem as a result of too many experiences like the gentleman who died in the hospital emergency room alone.

“We’ve had problems getting homeless people placed in hospice care,” Chambers said. “We knew we needed to do something about this.”

And so the Fourth Street Clinic did what the Fourth Street Clinic does best: It collaborated.

“We travel all over the country and we meet with other homeless service providers,” said Monte J. Hanks, the clinic’s client services director. “We are often on the cutting edge in terms of the services we’re able to provide here, and people ask us how we do it. The answer is simple: collaboration.

“We have an amazing community here,” Hanks continued. “It is a caring community, a faith-based community. Every faith group, every community service organization, every government entity is at the table, working together to serve the underserved in our community. We have a lot of people who care about our homeless population, and who want to make a difference.”

As a result of collaboration, a team has come together to launch Salt Lake City’s hospice for the homeless. The Fourth Street Clinic with its staff of 50 health care professionals will provide the medical resources needed for The Inn Between. Hanks said that several community hospice organizations are willing to provide hands-on hospice care pro bono. And Thorpe is coordinating efforts with the Salt Lake Interfaith Roundtable and other interested agencies to train and prepare surrogate families to add that much-needed link in the hospice chain.

“We will continue to try to reconnect these folks with their real families,” Chambers said. “But that can be a long process, and sometimes it just can’t happen. So these surrogate families will fill in the gaps and make the whole hospice program work in behalf of indigent people who are coming to the end of their lives.”

Training for the first group of family surrogates is currently underway. And the clinic recently received a two-year, $60,000 grant from the state — “Manna from heaven,” Hanks said — to temporarily cover the cost of hospice housing.

“Ultimately we would love to have a permanent home, a real home, where we can house 3-5 people at a time and care for them,” Chambers said. “That’s really the long-term answer, a place with a resident manager where people can rest comfortably and where volunteer surrogates can come and bring food and provide support.”

“That will happen,” Hanks said, the expression on his face firm and resolute. “I have no doubt of it. This community will make it happen. It always does. Look at what the Catholic Church does at the Weigand Center, or what the Episcopal Church does with their food pantry, or what (The Church of Jesus Christ of Latter-day Saints) does at Welfare Square, or what the Presbyterians and Methodists and Unitarians and just about every other faith group I can think of does here in this community.

“These are people of great faith, and they live it,” Hanks said, nodding and smiling knowingly. “Trust me. This facility will happen.”

Meanwhile, the state grant will help provide temporary housing for the Inn Between, while the faith community provides surrogate families to help bridge the gap between a cold, sterile death on the streets or in a hospital emergency room, and a death with dignity surrounded by love, kindness, compassion and faith.

For more information on the the Fourth Street Clinic and The Inn Between, visit fourthstreetclinic.org.