Breaking the Cycle of Homelessness with the Housing Stability Project

In a weekly skill-building class at Bailey-Boushay House, outpatient program clients are quietly finishing a journal entry. Group leaders Angela Brock, occupational therapist, and Billy Burton, clinical case manager, assure the group that sharing their writing is strictly optional: the real purpose is to help them manage feelings jumbled by transition.

Each client in the group has reached milestones in Bailey-Boushay’s Housing Stability Project. With support from the program, some are now in housing, and others are nearly there. Reading from loose journal pages, Antonio recounts a difficult moving day and facing the fortress of boxes in his new apartment. It’s this class, he says, that got him out of the house and talking about unpacking.

Annual Report - BBH

Angela Brock, occupational therapist, guides a group session.

Another client, Robert, says his entries are too personal to share aloud but he’s amazed by the relief writing brings. Next, Jeffrey reads from his last entry: “I have an apartment in my immediate future.” Words on a page have power, Angela tells the group, and she pledges to get everyone new notebooks by the next class.

About half of Bailey-Boushay’s outpatient program clients are homeless, many struggling with a history of substance abuse and mental health problems, while managing daily treatment for HIV. In 2016, outpatient program efforts to broaden support for both homeless and newly housed clients included:

Extended hours. Bailey-Boushay moved its opening time up 90 minutes to 6:30 a.m., accommodating clients displaced by shelters closing at 6 a.m. Executive Director Brian Knowles says not only are clients glad to get out of the cold and rain, but they have more time to shower, do their laundry and get services like therapeutic foot care. Because foot health is crucial for overall well-being, new socks are provided daily.

An onsite food bank. Often items available at regular food banks require cooking facilities or refrigeration, leading to waste. Because many client medications must be taken with food, hunger is not the only danger when food supplies and money are gone at month’s end.

A monthly food bank offered at Bailey-Boushay is designed around the wants and needs of clients. Single servings mean no spoilage; cans with pop-tops are in, as are foods known to taste OK cold. The onsite food bank eliminates another problem linked to food insecurity: chronic anxiety. No lines, no empty shelves, no being rushed to shop and enough choices to help clients feel empowered.

More life skills classes. The Housing Stability Project maintains a class lineup to meet clients where they are, with weekly drop-in groups for self-care, stress management, conflict resolution and relationship skills. Clients who excel are invited to join the Phase Two class (the journaling session above is an example), bringing together the same group each week to build relationships as they work toward setting longer term goals for a future taking shape.

Glenda, a client in the Phase Two class and an avid journal writer, told the group about making new choices and what it means when her doctors say she’s doing well. “It’s lifted my self-esteem,” says Glenda. “I’ve climbed the ladder of recovery for three years and I like what I see. I have more to do, but I know I can do it.”

A version of this story originally appeared in the Virginia Mason Health System’s 2016 Annual Report. Bailey-Boushay House, a skilled nursing and day health facility serving people living with HIV/AIDS and other life-threatening conditions, is owned and operated by Virginia Mason. 

Care Comes from the Heart at Bailey-Boushay House

Nurses at Bailey-Boushay House take on some of the most challenging patient care there is. But as you’ll find in the stories that follow, they wouldn’t want to do anything else.

Sarah Mulogeta, RN
Inpatient Program


Sarah Mulogeta, RN

Sarah Mulogeta first heard of Bailey-Boushay House in nursing school. Her good friend, a Bailey-Boushay volunteer turned patient care technician, told classmates all about the special place that cares for HIV/AIDS patients when there’s nowhere else to go. Sarah was intrigued.

“I thought of people with HIV back home where nobody wanted to get close to them,” says Mulogeta, who grew up in Ethiopia. “They are human beings with a disease who need our care. They need everything we can provide.”

When Sarah joined the Inpatient Program at Bailey-Boushay in 2009, most patients were battling advanced AIDS and HIV-related diseases, but that began to shift. As new medications allowed people to live successfully with HIV, Bailey-Boushay extended its unique care model for patients with Huntington’s disease, Amyotrophic lateral sclerosis (ALS) and other complex, life-limiting illnesses. Good care for patients who often can’t speak, have lost motor skills and may suffer from dementia demands something only Bailey-Boushay offers in abundance: a caregiver’s time.

Nine patients is the maximum Sarah will care for during her shift, a nurse-to-patient ratio unheard of in other facilities. And she’s not alone, backed by skilled patient care technicians, a charge nurse and a float nurse, all working together to create a good day for each patient. That might mean getting a patient’s chair adjusted just right. Carefully blending medications with a preferred food. Soothing a patient through a difficult procedure.

“The team I work with is my encouragement every day,” says Sarah. “The nurses and PCTs say ‘I’ve got you covered, we’ll do it together.’ Here everyone is involved, everyone can answer the call lights. If someone can’t help the patient they will find somebody who can.”

For Sarah, helping patients is also about helping the families, who are welcomed at Bailey-Boushayas part of the patient’s circle of care. Visiting family, spouses and partners are made to feel at home, invited to share meals and be with their loved one in any way that feels good to them. Sarah and the care team are prepared for anything, from giving families space to surrounding them with compassion and support.

“When I read cards and notes from the families, it means so much,” says Sarah. “It’s a blessing for me to be here. People who work at Bailey-Boushay do what comes from their heart.”

Kelly Richardson, RN
Outpatient Program


Kelly Richardson, RN

When Kelly Richardson, RN, landed her dream job in the Outpatient Program at Bailey-Boushay House, a first priority was learning clients’ names. About 270 people access the program every week to receive drug therapy for controlling HIV, and the support services to help them stay on it. The indispensable program element is trust, so Kelly started by walking the halls, greeting clients by name. Some looked surprised.

“Sometimes they’d thank me for knowing who they are,” says Kelly. “I think it’s a population that’s really misunderstood. They all have a story. It’s unbelievable what they’ve been through and survived.”

Kelly has known some of her clients for 10 years, from her days as a home health aide at a residential facility for people with HIV/AIDS. That facility closed in 2013, as HIV transitioned into a treatable, chronic illness and funding for residential care dried up. Bailey’s Outpatient Program fills a critical role by providing and monitoring complex medication regimens to prevent AIDS and the spread of HIV in the community.

HIV medication not taken consistently can cause viral resistance, and that resistance can be transferred to others. Some clients are already on “salvage therapy,” last-ditch HIV drugs that are hard to tolerate, increasing the odds for quitting them. Getting and keeping clients on the newer medications with less side effects provides the best chance for individual health and protecting others. That’s why Kelly’s job is far from that of a typical nurse.

“Nurses in the Outpatient Program work really closely with social workers because our clients might be struggling with homelessness, chemical dependency or mental health issues and need basic support to stay on their medication,” says Kelly. Along with their medications clients can get a meal or a shower, access counseling and basic health care, use a computer, join group activities or simply find connection with people like themselves.

For Kelly, every client visit is a chance to build a relationship: a key determiner of success with medication adherence. Nurses work in teams in the Outpatient Program, making it possible to give more individual attention. If a client comes in and needs to talk, Kelly’s nursing colleague can cover the floor, giving Kelly the gift of time with her client.

“My favorite part of the job is listening and engaging with our clients,” says Kelly. “When they open up to you it’s the best feeling in the world.”

Bailey-Boushay House is a skilled nursing facility owned and operated by Virginia Mason Health System.