Thursday, September 28, 2006

Housing Hell

I watched the cockroaches crawl around the clean laundry in the basket next to the couch as I took my patient's blood pressure. I noted the single-pane windows, wondering about the coming winter's bitter cold. My patient complained to me that this apartment--to which she moved after we requested a first-floor apartment for her---has floors which are harshly askew, causing her to fall frequently.

I wandered around the apartment, noting clearly that the floors do indeed slant in one direction or another in each room, at times to a considerable degree. Her daughters, able-bodied and young, say that even they sometimes lose their footing from the missteps they take on the floors which are not unlike those in a carnival fun-house. My patient, who suffers from arthritis so severe that she receives intravenous chemotherapy every two months, has a difficult time negotiating the apartment, a cause of much frustration and anger on her part. This move to the first floor from the fourth is fraught with new challenges, and perhaps has been for the worse.

When I first met her, she lived in the building next door on a fourth-floor walk-up, the stairs becoming an increasing challenge as her disability worsened. I drafted a strongly worded letter to the landlord asking for urgent placement in a first-floor residence, or a building with reliable elevators. The landlord responded quickly but didn't even give her a chance to see the apartment. Before she knew it, she was moving, and the askance floors were immediately apparent. Several falls later, I'm considering my next steps. This is housing "approved" for Section 8---hasn't it been inspected? Are there structural problems with the underpinnings of the building which might endanger those on the upper floors? There is obviously something wrong. While I am not a social worker, these are battles I often choose to wage, and this one may cost me a great deal of time and effort. But if she breaks a hip, all hell will break loose and I want to head that disaster off at the pass.

Substandard housing for the poor is commonplace all over the world, and the United States is sadly no exception. Even low-ranking soldiers in the military live in government-issued housing that most of us would find unacceptable. When did viable housing become a priviledge in this society? Probably around 1492.

In my time as a nurse working in the community, I have seen some housing situations which were utterly appalling. An older gentleman with a unilateral leg amputation who I used to know lived in a hovel behind his nephew's house, wheeling himself over floor-boards decrepit with age and rot, a large hole in the bathroom floor daily threatening to swallow his wheelchair. I've seen rats, cockroaches, holes in floors, broken windows, missing locks, lack of ventilation, stifling heat in summer, lack of proper heating in winter, the list goes on. Granted, some public housing is abused by some tenants, slums becoming such when they are neglected and trashed by uncaring residents. But one must look sociologically at the source of the rage that damages such properties. As I have said before, those who feel cast aside and uncared for by society will, by default, be uncaring for their environment, and perhaps for their own well-being. Our responsibility to house the needy is enormous, and we are, in my estimate, failing miserably on many fronts.

There are some examples in our area of excellent housing for the elderly and disabled. Nicely maintained, with common rooms, landscaping, excellent security and organized social gatherings, these residences could serve as models for others. On the contrary, one year after Hurricane Katrina, there are still squabbles about what type of viable housing---aside from FEMA trailers--- to provide for those displaced by the storm. Luckily, some groups of service-oriented architects are creating models of cheap, durable housing which can be freely copied and altered---in a manner similar to open-source freeware on the Internet---a practice which may transform the idea of affordable housing for the future.

But that future seems far away as my patient slips and slides along her not-so-fun-house floors, and my rising ire against a corrupt system which provides such abominable living conditions for the most vulnerable among us slowly turns to rage. The housing authority in the city in which I work has lately been revealed to be rife with corruption of the most reprehensible kind. A prominent family bilked the authority of millions of dollars over many years, allowing said family's members extravagant home improvements while the poor of the city languished in substandard dwellings. For those individuals who were sent to jail, good riddance, and their post-release community service should include five years of living in the worst of the public housing for which they were responsible creating and maintaining in its sorry state. If that type of corruption is not a source of rage, I don't know what is.

So, it seems that for all of us out there fighting the good fight on behalf of those not able to fight on their own and win, there are others who will take advantage, corrupt the system, and provide shoddy work and horrible conditions in the interest of saving money and advancing their own wealth. If it didn't make me so angry, it would bring me to tears.

Someone might ask, is this what a nurse does? Is this how a nurse thinks? Should a nurse even involve him- or herself in such societal issues? The easy answer is "of course". Physical, emotional, and spiritual health has myriad aspects and properties, and the health of the home, the place where one rests one's head, has an enormous impact on one's sense of health, safety, and groundedness. A home which does not offer that which a person needs for their own protection and security and comfort is a home which lessens that individual's ability to be whole, to be productive, to feel valued.

The frustration in the eyes and voice of my patient who is negotiating those off-kilter floors is filtering down into her sense of self, her sense of her relative health, her well-being, her groundedness. How can one feel grounded when the floor beneath one's feet can fool the eye and the foot? Housing certainly is a right, not a priviledge, and those rights are generally worth a good fight. I think I'll be taking off the gloves tomorrow.
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