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After ER visit, homeless woman has nightmare weekend

Fellowship Story Showcase

After ER visit, homeless woman has nightmare weekend

Picture of Isabelle Walker

Isabelle Walker provides an in-depth look at Santa Barbara's homeless community in a multi-part series running on Independent.com and HomelessinSB.org.

Part 1: Where do the homeless heal?

Part 2: Santa Clara hospitals give homeless a respite

Part 3: Post hospital stay is whirlwind of beds, programs

Part 4: JWCH gives L.A. hospitals a place to send homeless

Part 5: Shea finds, then loses, a bed to recuperate

Part 6: After ER visit, homeless woman has nightmare weekend

Homeless woman slips through service cracks
Santa Barbara Independent/Homeless in Santa Barbara
Thursday, November 10, 2011

Cindy McCallum said the two nights she spent on a grassy knoll opposite the Santa Barbara Rescue Mission were the scariest she’s lived through. The 53-year-old disabled homeless woman doesn’t say much about the night before she ended up across from the Mission -- the night she wandered the streets and stayed, at least part of the time, in the hospital’s parking garage. That was the night of October 28th, when the homeless shelter Casa Esperanza sent her to Cottage Hospital’s Emergency Room to be checked out for a possible stroke. It was the night she was discharged by ER staff to The Santa Barbara Rescue Mission with a bus token. Some details of what happened to McCallum between that Friday evening and the following Monday, October 31st, are still unknown. What is known is that McCallum -- who is cognitively impaired in addition to being partially paralyzed from the effects of a stroke -- spent an entire weekend outside, predominantly alone, unable to get up off the ground without assistance, use the bathroom or defend herself if she needed to. Her nightmare ended when a fellow homeless woman spotted her on Monday morning and called 911. She was brought to Casa Esperanza in a Santa Barbara police squad car.    

McCallum’s ordeal, which came to light through an anonymous tip, is a stark example of what can happen to uninsured homeless residents in South Santa Barbara County after a hospital stay if they are too medically fragile for a homeless shelter. McCallum, who does not drink or use drugs, plunged into a cavernous gap in services here when she was brought to Santa Barbara Cottage Hospital this summer after suffering two strokes. She does not know how she got here, only that she left her sister’s home in San Luis Obisbo County in June to attend her daughter’s graduation from college in Long Beach. On July 4th, she said, she suffered two strokes. Her daughter brought her to an acute care facility, but she somehow ended up in Santa Barbara and began receiving care at Cottage Hospital.

Sources at Casa Esperanza said McCallum was discharged from Cottage Rehabilitation Hospital to their facility around the 24th of October. But shelter staff said when they approved her for a medical bed, they did not know she was unable to dress or shower independently or that she was often incontinent. 
Casa Esperanza does not accept hospital patients unless they can dress, shower, and ambulate independently.

“Every morning I wake up wet and then I start crying,” McCallum told this reporter.

Cottage Hospital received a privacy waiver signed by McCallum freeing them to disclose information about her discharge and care. Last Friday afternoon, November 4th, Cottage spokesperson Janet O’Neill said McCallum’s case required further internal review before any information about her case could be released.

According to sources at Casa Esperanza, McCallum’s nightmare began Friday afternoon, October 31st. Between 4 and 4:30 pm, a staff member suspected McCallum was having a third stroke and sent her to Cottage Hospital's Emergency Room by ambulance. A  shelter staff member then called the ER to alert them McCallum was on route and instruct them not to discharge her to the shelter because of her great level of need. According to shelter sources, three hours later, ER personnel called the shelter and requested that McCallum be returned to Casa Esperanza. The shelter staff member said she could not.

Around 7:30 pm that evening, McCallum was seen on the street near the hospital, requesting directions to the parking garage. The next known interaction with McCallum took place that morning. McCallum said while in the parking garage, she bumped into a nurse she recognized from Cottage Rehabilitation Hospital. The nurse reportedly invited her back to that hospital where she gave McCallum a sandwich and bottle of water. At some point soon after, County Adult Protective Services (APS) was called to assist, apparently, because an APS case worker is noted as having called Casa Esperanza around 11 am asking if McCallum had a bed there. Again, the answer was no.

A staff member of the Santa Barbara Rescue Mission named Eddie Tyrell said during his Saturday shift, an APS case worker came onto the premises and explained she was leaving a homeless woman with slurred speech across the street. (The Rescue Mission does not begin letting residents inside until late afternoon.) Tyrell asked the case worker if the woman had been medically cleared to stay there, to which the APS worker responded she had. But Tyrell said he was unaware of McCallum’s paralysis and cognitive disability, so he did not check on her during the day. Knowing now just how disabled she was, he said he regrets not doing so. But, in the end, McCallum never crossed the street to seek shelter. Besides being unable to get up off the ground without assistance, McCallum didn’t understand the rules and requirements of the Rescue Mission. It’s unclear if help was offered by other homeless people or whether McCallum refused it.

Sources at Casa Esperanza said what McCallum requires is a skilled nursing facility (SNF). Yet no SNF in Santa Barbara admits uninsured people and, in addition, all SNFs require a physician to initially admit them and oversee their care.

Cottage Hospital spokesperson Janet O'Neill said ER staff discharged McCallum to The Rescue Mission on Friday, October 28th.   She was offered a cab ride, but declined it because she said she does not like to accept special services if she can get by with less. So she took only a bus token and recalled her plan to walk back to Casa Esperanza. She even asked a security guard for directions, she said. But she went to the parking garage instead because that’s where she left her purse weeks earlier when she was first admitted to the facility.

In an interview this summer, Todd Cook, Cottage Hospitals director of Care Management, said the hospital does not discharge homeless patients unless it can be sure it will be a safe handoff. In this case, that standard appears not to have been adhered to. This year, the hospital is giving Casa Esperanza $39 for every night one of their patients spends at the shelter, up to $150,000.

When a police squad car brought McCallum to Casa Esperanza Monday morning, witnesses said she was unable to get out of the car unassisted, was soiled, cold and frightened. Staff reportedly helped her shower and gave her clean clothes. She is staying again in a medical bed, though her needs remain beyond what the shelter can provide. Staff is pitching in to help where they can. Meanwhile, McCallum spends the bulk of her day curled up on her bed in the women’s dorm. She seems bewildered as to how she managed to end up in a homeless shelter. 

“What amazes me is how fast it all happened,” she said, recalling the July day she had her strokes. She remembers walking down the street with her daughter, looking for a place they could both get a pedicure. Apparently, they never found one.