Rush Hospital’s Angela Moss describes effort to protect homeless from COVID-19

Angela Moss begins every day of the week by strategizing with nearly a hundred front-line workers about how to protect Chicago’s homeless population from COVID-19. As the Assistant Dean of Faculty Practice at Rush Hospital, she brings a compassionate personal touch to the “MacGyver-style” innovation required to overcome the challenges of the effort.

“We love our patients very much,” she explained. “They’re very savvy and if they don’t like you, you can read it on their faces.”

Caring for Chicago’s west side homeless population has been part of Rush Hospital’s standard operating procedure for more than three decades. When Mayor Lightfoot implemented a system to confront the pandemic on their behalf, Rush was named one of the program’s leaders.

In an exclusive interview, Moss describes the evolution of the city-wide partnership, the success of its efforts, and the everyday ways that Chicagoans can offer their support.

How did the effort to protect the homeless population from COVID-19 start?

It was a conversation with Dr. David Ansell and Dr. Steve Rothschild, who have been working with homeless people and shelters for a long time. We decided to focus on getting ahead of the situation because very likely there will be an outbreak in that group, which is a risk for the public at large.  

How has the effort evolved?

The original idea was just, let’s call a meeting, get together and brainstorm about what we can do. We meet at 8 o’clock in the morning, seven days a week. Anyone can join. When we started, it was maybe ten people. Now we have more than 80 members on that phone call: providers like us, social workers, disease specialists, the city, aldermen. We even have an ethicist.

How is the city involved?

They’re with us every step of the way. We might have an idea ‑ like, we need multiple isolation units for high risk and low risk patients ‑ and the city’s like, you got it. The CPD is also busy. I don’t even think they are sleeping.

What is a typical morning call like?

Someone will say, ‘I have an outbreak over here, what do I do?’ And a tech or someone will say, ‘I’ll call some of my colleagues, and we’ll get a team there by one o’clock.’ It’s kind of beautiful.

We’re talking about writing a white paper to share with other cities. We recruited some doctoral students to help, because most of us are on the front lines. I’m usually at a clinic or a shelter.  

What kind of relationship did Rush have with program partners before the effort began?

We’ve had very deep relationships with many of these partners. Rush has been running a Tuesday night at the Franciscan Homeless Shelter for years. We’ve also had a group onsite at Safe Haven. In my department alone, we had 24 partnerships that existed pre-COVID.

What are the general guidelines for treating patients experiencing homelessness?

The straight care is pretty basic: you let the virus run its course and you make sure that it does not get to the point where acute care is required.

The hard part is getting them to a place where they can safely practice social distancing. People experiencing homelessness have a high risk for comorbidities (the simultaneous presence of two chronic diseases or conditions in a patient). There’s not really a way for them to self-isolate or wash their hands all the time. I have medical expertise, but I don’t know a lot about housing. That’s where the partnership comes in.

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How do you prepare nurses to work with people experiencing homelessness?

The care for people in these environments is different from bedside care in a hospital. There are different competencies that you must have. You can advise them to wash their hands, but they don’t have a sink. You have to troubleshoot. It’s kind of like a MacGyver-type of skill set: ‘okay, we’re going to figure this out.’

For people who have a history of PTSD or mental diagnosis or neglect, you have to be careful with your words and your approach. You have to be gentler. You have to be in the moment and you can’t think, ‘oh, a patient is a patient is a patient.’ That’s not the case.

I tell the nurses, whatever kind of unconscious bias you may have about the homeless, recognize that and figure out how you can address that. There are all kinds of preconceived notions about homeless people, like, ‘oh, they’re all drug addicts.’ If you’re a person who thinks that, gather your own information and figure out how to bust that myth. You can’t say, ‘I’m going to do what’s best for you,’ if you don’t know the person you’re treating. 

How well do your patients experiencing homelessness understand what’s happening?

There is a very high level of fear and anxiety in the homeless group. It’s just devastating. They’re hearing the same news everybody else is hearing, like, ‘stay home,’ but they don’t have homes. But the crisis also magnifies the beautiful. One of my patients, an older gentleman, got out of the hospital yesterday. I asked him, ‘how did it go?’ And he said, ‘with this crisis, I think they’re just nicer. Everybody was so compassionate.’

How did focusing on homelessness become part of your career?

I started out as a critical care nurse helping really sick people, but I didn’t feel like I was having an impact. So I went back to school and became a nurse practitioner and started to work with the community, because it’s more upstream, a term we use to describe preventative care. I felt that we were doing an okay job with people of means, but I thought we were doing a terrible job with marginalized populations. So it evolved from there. The MacGyver theme ‑ using my skills to address a problem that has no traditional solution – has been my guiding principle all the way through.

Can you give me an example of the MacGyver theme at work?

I needed to find a blood pressure machine for an isolation center. You know, the machines they wheel into the examination room. I put out an APB and found one and went to pick it up, but I really had not thought about how I was going to transport it. I was rolling it down the street and I thought that the police might think I’m stealing medical supplies. I rolled it to my car, a Toyota Venza, and I had to pick it up and it’s top-heavy and I would try to put it in the car but it would roll out the other side. I finally loaded it in and, even though one of the wheels was sticking out of the window, I took off.

How can our readers help make your job easier?

Donations. Not donations of money necessarily, but donations of things. Blankets and new socks and underwear. People in shelters are being moved around because of COVID-19. They get to a new facility and they don’t have what they’re used to. I think I’ve had four requests for new underwear over the past two days. The kids also need things to do.

One of the nurse practitioners on our team took a walk with her dog and, when she returned, her neighbors had loaded her porch with supplies: travel toiletries, blankets, etc. It uplifted our spirits because we could see that we have a lot of support. It’s kind of like when people cheer from their homes every night: the crisis can be isolating, but we have each other.