The Clinic the House Built

THE BLANCHET HOUSE of Hospitality may be the busiest restaurant in all of Portland. Since its founding in 1952, the organization’s mission has been simple: provide warm meals to whoever walks through its doors, without question. Six days a week, the social service agency serves three meals a day to between 1,000 and 1,500 homeless and impoverished Portlanders.

The diners are men and women, young and old. Some carry backpacks laden with possessions. Others use walkers or wheelchairs. A few mind their children. They all sit at tables of four where they are served restaurant-style by volunteer servers. There are easily 100 people in the space at a time, coming and going throughout the day, but often the loudest sounds are the quiet clink of silverware or the sound of a plastic coffee mug hitting a table’s surface.

Through the kitchen and down a short hallway, two undergraduate nursing students from University of Portland’s School of Nursing are available to the Blanchet House’s 58 male residents and diners who can come to the students for care of minor ailments and injuries.

Over the last decade, the Blanchet House has grown to add 58 units of housing for formerly homeless men, as well as health care services in the form of nursing students from University of Portland who do their clinical rotations at the Blanchet House. Now, to address a shortage of primary care providers and lack of access to health care, the Blanchet House will add a fully staffed nurse health clinic, which would be the first nurse-led primary care clinic founded with an academic partner in the state of Oregon.

AT THE CENTER of the efforts to establish this clinic are three UP alumnae: Emily Harrington, Kay Toran, and Kelly Fox.

Harrington, a family nurse practitioner, is a UP double nursing alum (’03, ’06) and the first woman to serve as the president of the Blanchet House’s board of directors. Toran ’64 is the president and CEO of Volunteers of America Oregon, an organization that offers wide-ranging services to those in need—from correctional re-entry support to affordable housing, as well as assistance to the homeless, to those living with a disability, and to families and children. Kelly Fox ’90 is the assistant professor of nursing leading the charge on new clinical and telemedicine curriculum for UP’s nursing students.

The nurse-led clinic—under current plans, it will be called the Harrington Health Clinic—will provide primary care to the Blanchet House’s residents. Two UP nursing students doing their rotations will provide the bulk of care, under the supervision of an onsite nurse practitioner.

Volunteers of America, which has expertise in providing care to vulnerable and at-risk individuals, will oversee the administrative functions of the clinic, which it already does in its other services: They will enroll clients in the Oregon Health Plan and other insurance plans, maintain clients’ electronic health records, and manage the billing, scheduling, and other administrative aspects of the clinic. Volunteers of America Oregon will also provide mental health counseling and Substance Abuse Disorder treatment services to individuals referred by the nurse health clinic.

Harrington thinks that to serve homeless people effectively, services must be cohesive and support one another. She thinks of it as a three-legged stool: housing, employment, and health care. So while the full-fledged clinic is a big step for the Blanchet House, it is needed. “If we are feeding people and providing them shelter…part of that restoration should be engaging in the physical and the mental health of these individuals.”

Harrington hopes the Blanchet House can honor its past while also tapping into the strengths and training of nursing professionals. “There’s that simplicity in our mission of offering a warm meal, offering shelter without question, and meeting people in stride and accepting where they are. It’s really beautifully aligned, I think, with how nursing care is delivered.”

Toran and Volunteers of America Oregon became involved in the project in early 2019, when Toran was meeting with staff of UP’s School of Nursing on a different project. (Toran has been a member of UP’s Board of Regents since 2006.) The more she met with the UP nursing staff and Blanchet House, “the more we could see where there is synergy, there is opportunity,” Toran says.

IN 2018, HARRINGTON became the president of the Blanchet House’s board of directors, after serving on the board for five years.

But her relationship with the Blanchet House began in a far humbler way, when she was a student at Central Catholic High School, which requires students to volunteer and be of service each year. Harrington served meals at the Blanchet House during her first year. The following year, she served meals at St. Francis Dining Hall. Part of the requirement of those volunteer duties was then spending the night at the shelter and, the next day, panhandling enough money for lunch.

She walked underneath Portland’s bridges and visited the homeless camps under them. As she spoke to the people she met, she realized “the differences between their lives and ours was imperceptible,” she says. “They’d had a snowball of bad things happen. Many of them had lived fairly normal lives.”

Both Harrington and Toran are convinced that homelessness in Portland can no longer be ignored. Harrington, who is at the Blanchet House at least once a week, says she has watched as the demographics of homelessness has changed to include more families with young children and elderly people dining at the facility.

“[Homelessness] has certainly become in our face in our very city, and people are losing their compassion and becoming more and more jaded,” Harrington says.

Homelessness in Portland, as everywhere along the West Coast, has grown dramatically since the 2008 Great Recession. According to the city-county Joint Office of Homeless Services, there are 4,015 people who are homeless in the region.

Harrington got the idea to start the clinic by seeing the “enormous need” of the 58 residents in the Blanchet House’s transitional housing program. More than 95 percent of them are on the Oregon Health Plan, and it is common for them to wait weeks to months to see their doctors.

The Blanchet House, in partnership with UP’s School of Nursing, has been systemically addressing these challenges in recent years and has become part of the School of Nursing’s curriculum. Kelly Fox has largely been responsible for implementing these curricular changes for UP’s student nurses, drawing on her experience establishing nurse-led clinics for employers. Every six to eight weeks, two nursing students do their clinical rotation at the Blanchet House, either for their community or mental health rotation.

They play the role of a community or public health nurse: Once a week, they teach classes on all manner of topics including nutrition, mindfulness, ways to cope with stress, first aid and basic care, and sleep hygiene. They also meet individually with the male residents to provide community-based care—such as blood pressure checks and flu shots.

Fox also saw the potential benefits of providing telemedicine to Blanchet’s residents. Starting in 2018, the Blanchet House, through a partnership with Providence Health & Services, began to offer telemedicine—the ability to Skype with Providence nurse practitioners in order to access immediate acute care for diagnosis and treatment of minor illness and injury.

The nursing students help clients use the telemedicine portal at Blanchet, which Harrington says fills a serious gap in health care: a shortage of primary care physicians, which sometimes makes for the long wait times.

 GROWING UP, HARRINGTON saw firsthand how nursing can effect social change: her grandmother and two of her aunts are also alumnae of UP’s School of Nursing. “The craft of nursing is providing that one-on-one attunement, being very person-centered,” she says, helping patients—especially vulnerable ones—“know that they’ve been heard and that someone else is wanting to hold them in that embrace, too.”

Social workers have this same person-centered focus. And social work is the field where Toran began her career. (After getting her BA in sociology and psychology from UP, she earned her master’s in social work from Portland State University and became an assistant professor there.) Toran describes the foundational tenets of her work as the following: “integrity, excellence, inclusivity, and respect for those who are different, who are challenged, who have less than most.” While she was at UP in the 1960s, she was inspired by people standing up for social change—she, along with many in her cohort, participated in the protests against the Vietnam War and advocating for civil and women’s rights. From there Toran has built an extraordinary career, centered on finding solutions to big, seemingly intractable societal challenges. Before leading Volunteers of America Oregon, she was director of Oregon’s State Services to Children and Family and was Oregon’s Affirmative Action Director under Governor Vic Atiyeh. She has a reputation for centering the underserved and including their voices in the work to find solutions.

In many ways, Harrington, Toran, and Fox all echo the values that led to the Blanchet House’s founding. Eight men, who were students at University of Portland and inspired by the values of the Catholic Worker Movement, began serving soup out of a truck to impoverished Portlanders living in Old Town. Eventually, and under the guidance of Father Francis Kennard, they rented and then bought an abandoned brothel that became the Blanchet House.

“They believed in…the essence of dignity and humanity [in each person],” says Fox. “How they saw that expressed from a social justice standpoint…is that each individual deserves a warm meal.” With this new clinic, the leaders at Blanchet House are expanding this initial vision to the overall health and wellness of their guests.

THE BLANCHET HOUSE’S board of directors heard a presentation about the clinic during its January 2020 board meeting, and the board—along with Volunteers of America Oregon and University of Portland—are moving “with great speed,” Toran says, to complete the necessary due diligence before a memorandum of understanding among all the organizations is finalized.

It is still unclear which entity will be the legal owner of the clinic—legal ownership will be addressed in the memorandum of understanding, and currently, it is expected the Blanchet House will be the clinic’s legal owner.

Toran says each organization is now defining what its particular role in the clinic will be, along with identifying financial responsibility and other questions that the “boards [of directors] want to know.”

It’s unknown at this point when the clinic will open.

“All of the partners are proceeding and planning that the clinic will open soon,” Toran says. “We have some serious challenges in Portland with our homeless population. What I love about this clinic we are developing is that all of the partners are talking about solutions.”

AMANDA WALDROUPE is a journalist and writer based in Portland, OR. Her feature writing focuses on homelessness, poverty, inequality, other social justice issues, and politics.