Who lives at St. Joseph’s House of Hospitality? About a third of the residents are Vietnam veter- ans. This is not surprising because veterans comprise about 47 percent of the nation’s homeless (National Coalition for Homeless Veterans, 2009). Some Vietnam veterans were on the streets for many years. Many suffer from what Tick (2013) called “soul wounds,” moral injuries associated with what they saw, did, or failed to do while they were in combat in Vietnam. Sherman (2015) also spoke to spiritual pain among veterans from the Iraq and Afghanistan wars. Like their counter- parts from the Vietnam War, these veterans are seeking to reconcile their sense of goodness with their behavior during war.
Veterans at St. Joe’s have the most access to social and health benefits because they are eligible for many U.S. Department of Veterans Affairs (VA) programs, notably health care, case manage- ment, and access to the Housing and Urban Development (HUD) VA supportive housing vouchers (HUD-VAS) (National Coalition for Homeless Veterans, 2009). Some have other veterans’ bene- fits. All have access to the local VA hospital or clinics affiliated with the University of Pittsburgh.
Social workers and case workers from the local VA work with the staff at St. Joe’s to find jobs and/or independent housing for veterans.
Another group of residents struggle with a chronic brain disease, addiction. Although these residents are not actively engaged in drug or alcohol use, they know and experience the cravings of recovering addicts. Veterans compose a subgroup of residents who have experienced addiction.
St. Joe’s, a protective environment, does not allow drugs or alcohol to be brought on its campus or consumed there. Residents who violate this policy are asked to leave. Some violators of the alcohol and drug policies have been barred from the property.
Another third of the residents live with chronic mental illness. Many of these men have symp- toms of their mental illnesses and/or display side-effects from a long-term use of psychotropic drugs. Veterans are a subgroup of men diagnosed with mental illness. The afflictions of the men with mental illness are apparent. Some speak openly about their depression; several residents talk or sing to themselves.
A small group of the residents came to St. Joe’s when their mothers or sisters died or could no longer care for them. These men are the senior residents, having lived at St. Joe’s for 20 or 30 years.
St. Joe’s mission is unique; it is a residence for previously homeless men. Founded in July 1937 on the principles of Dorothy Day’s Catholic Worker Movement and directed by Monsignor Charles Owen Rice, a controversial Catholic labor priest, it began as a soup kitchen on Wylie Avenue in the Hill District. The following year, the House of Hospitality moved to Tannehill Street in the Hill and opened a shelter for men who needed places to sleep as well as hot meals. In 1974, the House of Hospitality moved to its present location on Bedford Avenue, which was formerly Roselia Maternity and Foundling Hospital operated by the Sisters of Charity of Seton Hill (Sisters of Charity of Seton Hill, n.d.). The sisters continued to live and work at St. Joe’s; several home- less women also came to live there. When Bishop Wright appointed Monsignor Paul Bassomp- ierre as director in 1952, members of the St. Vincent de Paul Society became a sustaining part of 126 Chapter 11 The Boys on the Porch: Life Among Previously Homeless Men
St. Joe’s (“Paul Bassompierre,” 1985). In 1982, the Diocese of Pittsburgh turned its management over to Catholic Charities of Pittsburgh, part of Catholic Charities USA (Catholic Charities of Pittsburgh, 2016). Catholic Charities USA has diverse programs along the housing continuum to prevent homelessness, including 201 shelters, mortgage assistance, and foreclosure and income assistance (Catholic Charities USA, 2014).
St. Joe’s is a four-story brick building on a campus with a large yard, a pavilion, a vegetable gar- den, and a tennis court. There are squirrels, birds, and wild cats who sometimes are adopted by the men. It has 60 private rooms, lounges, small kitchenettes, offices, a large dining room and kitchen, a chapel, a laundry room, storage facilities, and an elevator. In the last several years, the building and bathroom facilities have been renovated to make them more accessible to handicapped res- idents and staff. The building is now wired for Internet and cable access. At night, a professional security guard sits at the front desk and makes rounds throughout the residence. New rules or reminders about old rules are posted on the elevator. The boys on the porch watch the neighborhood and everyone’s comings and goings.
It is evident at St. Joe’s that poverty and/or a lack of affordable housing are not the only causes of homelessness. Although it has changed locations and management over the years, St. Joe’s mis- sion is spiritually and culturally united to the vision of Dorothy Day, Father Charles Owen Rice, the Sisters of Charity of Seton Hill, Monsignor Bassompierre, and the St. Vincent de Paul Society. Given their history and ethos, it is not surprising that St. Joe’s policies and practices are unique among the shelters and residences for homeless persons in Pittsburgh.
The men at St. Joe’s are older than typical shelter residents. They are middle age (over 55) and older men with limited incomes. They can care for themselves, manage their medications or treatments, and pay rent based on a sliding scale. While there are no criteria specifically related to physical health status, residents at St. Joe’s must be free from use/dependence on drugs and/or alcohol. Each resident must be able to live peacefully in a group setting and manage his addictions and/or have some con- trol over his mental health problems. Fighting, possession of weapons, or other violent behaviors are not tolerated. Some residents have significant physical problems, and many take psychotropic med- icines and/or are under treatment for their psychiatric conditions. Some attend Alcoholics Anony- mous (AA) meetings and/or recovery groups at St. Joe’s, at the VA, or in the city.
Each man has a private room with a lock. St. Joe’s residents are not required to leave the residence in the morning or stand in line to claim a bed at night. The National Law Center on Homelessness and Poverty (2014) points out that behaviors such as falling asleep, standing still, or sitting down, legal when done privately, can be criminalized when they occur in public by people who have nowhere to go. The men at St. Joe’s no longer have to leave their resting places in the mornings. They have three home-cooked meals each day, a wide range of programs, and special treats and enter- tainment from community and church groups. Lounges on each floor have cable TV, and there is a computer room and computer classes. The men have access to coin-operated washers and dryers, weekly linen service, a small store where they can buy snacks and toilet articles, and a clothing room where they can select slightly used clothing. Religious services are held on weekends and there is a bible study group. The men are assisted in person-to-person relationships by a full-time staff, case managers from the VA, and a former VA nurse who volunteers 1 or 2 days a week. Spiritual care and support are provided by priests and ministers of local churches. The men are encouraged to seek preventive health services, notably immunizations and foot care, and attend programs that address addiction. Some are outpatients at LIFE Pittsburgh, a Medicaid managed-care group, or at VA clin- ics. Once a month, there is a house meeting and a welcome celebration for new residents and resi- dents who will celebrate birthdays during the month. Some residents work at St. Joe’s or in the city, and a few go to school. Some own cars, parking them in the parking area in the front of the building.
Introduction 127
Port Authority buses stop near the residence. Each man signs out/in when he leaves and returns to the house. He does not need to tell anyone where he is going.
▸ The Men on the Porch
Perhaps it is easier to understand the vulnerability of previously homeless men by meeting some of the men. James is a 78-year-old White man who is short of stature; he is developmentally chal- lenged. He came to St. Joe’s when his mother died over 30 years ago. His days are rather ordinary;
he has a routine and a special chair in the front parlor. He watches who comes and who goes. He is popular with the men. They look out for him and call him Little James. One of the men takes his order for the store each week. It always includes paper towels and oatmeal cookies. The manager shops for him and James always pays for his order before he receives it. Last summer, James became suddenly ill and was transported to the emergency department of the closest hospital. Because of privacy rules, it was difficult for the men on the porch to find out what was going on. There were discussions on the porch about James. The men said that James had cancer; they thought it was stomach cancer. He was very sick and was frightened. The hospital where James was a patient was not far away. The case manager and a few of the men on the porch decided to visit him. They found James crying and curled up in a hospital bed. When he realized that his friends were there, he be- gan to sob. He told them he was going to die. They learned that James had colon cancer and was scheduled for surgery. As James cried, his visitors looked on sadly; the case worker had tears in her eyes. One of his visitors, a leader on the porch, got up and went over to his bed. He put his hand on James’s knee and asked, “James, do you know where you are?”
James said no.
“Kenny said you are at Mercy Hospital, the best hospital in Pittsburgh. The doctors and the nurses will not let you die.”
James sat up in bed. He asked Kenny if what he had just said was true. Kenny did not hesitate, and said, “James, you are going to get better and come back to St. Joe’s.” James heaved a great sigh of relief and began to talk with his visitors. James survived the surgery. He went to a skilled care facility to learn to walk again and recover his energy and strength. He never quite mastered the care of his colostomy, although he tried. Fortunately, the surgeons were able to close the colostomy and restore the integrity of his colon. James came home to St. Joe’s and resumed his routine.
▸ Vulnerability
Vulnerability is a term used to describe persons who are economically and/or socially disadvan- taged. They may be members of minority racial, ethnic, or religious groups; they may lack adequate health insurance, safe housing, reliable sources of food, or access to health care, the social determi- nants of health (Centers for Disease Control [CDC], 2017). Age is also a determinant of vulnera- bility. Infants, young children, pregnant women, and the aged are always included in classifications of vulnerable people. Sexually transmitted diseases, HIV/AIDS, mental illness, addiction (Aday, 2001), or conditions that compromise the immune system and threaten a person’s well-being are frequently noted in the literature about vulnerable populations (DANIDA, 2000). Shi and Stevens (2015) suggest that vulnerable populations are disadvantaged, lack privilege, or are of low social class. Flaskerud and Winslow (1998) characterize vulnerability in terms of diminished autonomy, poor quality of life, and increased morbidity.
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Supporters of the Affordable Care Act have argued that lack of health insurance increases vul- nerability (Center for Health Care Strategies [CHCS], 2014). Grabovschi, Loignon, and Fortin (2013) posit a relationship between vulnerability and health disparities. Flaskerud et al. (2001) analyzed articles published in the nursing research literature over five decades (1952–2000) that discussed health disparities among vulnerable populations: persons of color, those living in poverty, those marginalized by their immigration status or sexual preferences, those with diverse ethnicity and/
or religious practices, and those with other marginalized social statuses. Homelessness was not a dominant category in the literature that was reviewed.
French sociologist Pierre Bourdieu (1986) introduced the notion of capital into the discussion of vulnerability. In his analysis of power, Bourdieu explained that vulnerable people lack power as measured by their levels of economic, social, and cultural capital. Aday (2001) borrowed Bourdieu’s notion of capital to identify and describe social capital (family structure, marital status, member- ship in voluntary organizations and social networks) and human capital (level of education, occu- pation, work status, income, and housing) in her work to lessen vulnerability.
▸ Social Capital of the Men at St. Joe’s
Although James had a family who cared about him, families are rarely mentioned by the men at St. Joe’s. Some speak lovingly of their parents, especially their mothers, but they rarely discuss broth- ers, sisters, spouses, or children. The absence of family engagement was discussed when Peter, one of the men on the porch, had a cardiac arrest. He was taken to the nearest hospital and placed on life support. No one could find his next of kin. A former lieutenant colonel in the Air Force, Peter’s record noted that he was married and had a daughter. He had no will and had not designated any- one to speak for him if he were not able to make his wishes known. The county eventually hired investigators, but his family could not be found. After several weeks, the hospital was allowed to discontinue life support.
While this example is extreme, it portrays some of the men’s social isolation. The men at St. Joe’s are not joiners; many have lost church affiliations, contact with their families, and their former way of life. A few are active in AA and attend regular meetings at St. Joe’s or in the city.
The notable exceptions are the veterans who identify with their branch of service and with the VA.
The men at St. Joe’s have their own support systems. They rely on each other and on some cur- rent or former staff members. Several weeks ago, I admired Leo’s sweater. The weather had changed and his sweater looked warm and new. Leo patted the sweater and said Mary gave it to me. He then extolled Mary’s virtues. “She is a good girl. She cleans my room and takes care of me. She came here as a young girl, got married and had kids. She is a good girl.” He then became very serious saying,
“Mary is a good girl; they don’t pay her enough.” This was the longest conversation that I have ever had with Leo in over 2 years.
The men know each other’s habits and look out for each other. They tease and sometimes seek to embarrass each other. They argue, especially about sports and politics. Some men knew each other on the street, and a few encouraged their buddies to come to St. Joe’s. They have an informal referral and information network. Its hub is the porch. There are real friendships between some of the men, notably among the boys on the porch.
When one of the men, a long-term resident of St. Joe’s, died at the hospital, he was brought back for his wake and funeral liturgy. His friend at St. Joe’s met his body at the door and accompanied it to the chapel. The men formed a funeral procession behind him. A retired chaplain welcomed residents, staff, and former staff to the funeral liturgy.
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The men at St. Joe’s live in the present. Their futures are uncertain. They have aged beyond their years and many suffer from chronic physical and emotional illnesses. There is little discussion of the past. When the men talk about their former lives, they seem to be describing a movie or events that went on around them. It is difficult to accurately assess their social capital.
▸ Human Capital of the Men at St. Joe’s
While the social capital of the men at St. Joe’s could be enhanced, many have human capital. If you view homeless men as poor, uneducated, shiftless, and dangerous, you are not describing the men at St. Joe’s. Several residents have graduate degrees; one is currently a doctoral student at a nearby university. In their former lives, the men were chemists, college teachers, and ship captains. Oth- ers were professional photographers and cooks. One is an artist. Many worked in the steel mills and mines that were such a part of industrial Pittsburgh. Others were plumbers, painters, electri- cians, and handymen. Some have pensions or trust funds. I know a story about a former resident at St. Joe’s. His financial adviser told me about a wealthy client whose spending habits changed very suddenly. When she visited his home, she found many boxes. He could not explain what was in the boxes or why they had not been opened. She encouraged him to seek help, but his pattern of spending continued and the number of unopened boxes increased. Eventually, he squandered his assets and became a resident at St. Joe’s.
Economically speaking, the residents at St. Joe’s are at or below the poverty level. Most of the men had worked; some had owned property. Some cannot afford the cost of living there. A few res- idents pay their rent by working at St. Joe’s. One of the men on the porch who works in the kitchen jokes about all the jobs he lost in his life. His experience is not unique. There are many studies in the United States and around the world that show an association among mental illness, addiction, and poverty (Costello, Compton, Keeler, & Angold, 2003). Mental illness, addiction, violence, and/
or post-traumatic stress disorder (PTSD) have altered work histories and personal and family lives of the men at St. Joe’s.
Part of St. Joe’s mission is to help the men live independently. Men are encouraged to go for job interviews and place their names on lists for subsidized housing. The men at St. Joe’s are not homeless, yet many lack the personal or economic resources to live independently in the commun- ity. When a resident leaves St. Joe’s, the men on the porch discuss how well he will do. Because it appears that no one who left has ever come back in recent years, it is hard to know if their predictions are correct. Some of the men are dependent on St. Joe’s. For example, long before his cancer diag- nosis, James had cognitive and physical impairments that required him to be helped by others. The majority of men at St. Joe’s once had independent lives. Yet they found themselves homeless, living on the streets, begging for money or food, being insulted by passersby, and bothered by the police.
Life on the streets is hard. It is not surprising that many of the men look older than their stated age. As noted, some men have significant chronic physical or mental health problems that make living alone difficult and even dangerous. Although you could argue that previously homeless men are vulnerable, using Aday’s criteria (2001) it would be hard to say that James and the other men are bereft of social or human capital.
At times, I have had conversations with the boys on the porch about how they see life and themselves. James is at home. Although he is single and has no living relatives, he has a home, an address, and people who look out for him. Former staff members and the nurse who volunteers visit him. The men help and protect him. At St. Joe’s, James is a person with a name, an identity, capital, social status, support, and friends.
130 Chapter 11 The Boys on the Porch: Life Among Previously Homeless Men