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Taking time honors unhoused patients

Robert Lippman learned from his mother the value of time.


By Mary Stamp

As manager and behavioral health care provider at the Providence Community Clinic, Robert Lippman applies what he learned from his mother about the value of taking time.

"It's a way to honor her every day as I engage with those who are homeless," he said. "Time is essential to our service. Many health care providers are restricted to seeing each patient for 15 minutes, but we are able to provide dignity through the gift of time, which may result in an hour visit.

"For those who are often looked past, ignored and avoided, it's a priority for us not only to give them our time but also to honor their time. It starts with knowing people by name. We take a picture of them for their medical charts. We take their socks off to check, clean, bandage and restore their feet. We take time to listen regardless of whether someone is wrestling with addiction or experiencing an episode," he said.

As they listen to individuals' needs, they also listen for community needs beyond health care.

Robert, who graduated from Northwest Christian High School in Spokane, said his late mother, Judy Lippman, a social worker and Spokane tribal member, grew up on the reservation but lived in Spokane, taking him to the reservation for family events.

In 2010, he earned a degree in social work at Northwest Nazarene University in Nampa, Idaho, then a master's in social work in 2012 from Eastern Washington University, and a doctoral degree in behavioral health in May 2023 from Arizona State University.

Robert worked seven years with Horizon Hospice, where people at the end of their lives value taking time. In 2018, he began at the Providence Community Clinic.

"I was 'conditioned'—not called—into this work. Growing up I was routinely exposed to my mother's love in acts of service and quality time. She loved those in her proximity by sheltering them in times of need. Family members came first, especially those going through difficult times," said Robert. "Sometimes she lovingly asked to use my room, explaining the circumstance and 'conditioning' me to love as she loved.

"I am comfortable around people wrestling with their circumstances," he said. "Time reassures people they are not alone. That's our clinic's narrative. From our standpoint of privilege, we remind those in need, they are not alone."

Robert's mother reminded him of his privilege. She told him, "To those to whom much is given, much is required."

He did not gain this perspective overnight. He finds his valuing time ironic.

"In my younger years, I was frustrated by the time my mother took to eat, shop, drive, walk or get ready to leave. We were always late. I was always frustrated. Ignoring her physical limitations and chronic pain, she gave much and required nothing, giving unconditional love that mirrored her beliefs," he said.

"We are like a field waiting for the daily harvest," said Robert, noting that coming to harvest takes time.

He also likens the clinic's mission to the story of the prodigal son as it represents five stages of change: pre-contemplative, contemplative, preparatory, action and maintenance.

In the pre-contemplative stage, the son leaves and spends his father's inheritance, living as he wants. In the contemplative stage—living with the pigs—he realizes it was better at home. As he prepares to return, he wonders what he can say to his father. In the action step, he returns and finds his father waiting in the field, rushing to him and throwing a party. In the maintenance phase, the brother asks, "How is it fair?"

"In our clinic work, we are waiting for whoever walks in, meeting them where they are. Our clinic is a platform for those seeking to both provide and receive quality care," he said.

"When someone wants validation that they are not alone, they return to the culture we have built," said Robert, noting that this approach has resulted in a 56 percent increase in clinic visitors.

"We are a walk-in clinic for those disenfranchised and unable to make appointments. We encourage people to come back when we are open—7:30 a.m. to 5 p.m., Mondays, Tuesdays, Thursdays and Fridays. We are closed Wednesdays and weekends."

"The clinic is small but mighty," he described. "Just five are on the staff, but our efforts are expanded by an eclectic group of volunteers—12 physicians and registered nurses."

In addition to Robert, other clinic staff include a nurse practitioner, a medical assistant, a front desk patient coordinator to navigate insurance enrollment and a clinic supervisor heading outreach.

Each volunteer has a unique schedule—half a day a month, one day a week, two days a month. They plug in based on when they are available or when there are gaps in the schedule.

"We need more volunteer providers and nurses so we can help more people," he said.

Volunteers are mostly retired and current physicians, surgeons and nurses at Providence. The clinic welcomes those from other health systems, too.

Some days 15 to 25 patients come to the clinic. Other days eight may come.

Founded by Sr. Peter Claver, SP, in partnership with the local House of Charity with volunteer providers serving people in the shelter, it moved in 2017 to 32 W. 2nd as Providence Community Clinic.

Most patients walk to the clinic from the House of Charity or one of the seven permanent supportive housing units nearby.

Some volunteers see people at the clinic. Others go to shelters and day centers—Monday afternoons at the Trent Shelter, Tuesdays midday at City Gate and Friday mornings at the downtown library.

"People experiencing homelessness are often hesitant about the healthcare system that emphasizes appointments, because time is irrelevant to them. Scheduling a month ahead does not stay as a priority," Robert said. "Appointments work for people who have beds to sleep in regularly, transportation and know where their next meal will come from. On the streets, people worry about their safety and where they will sleep or eat. So urgent care and emergency departments are often the most accessible."

As a contingency clinic, it uses a situational approach to reinforce positive behavioral change, he said.

"We listen to a person's narrative. Patients come as they are," Robert said, noting that many have had fragmented care, so their chronic physical and mental health conditions are inappropriately managed.

"We do not let a health condition take over a person's humanity. We piece together the puzzle for those with no primary or specialist providers," he said. "We partner with other service agencies and specialty care providers—like psychologists, audiologists, dermatologists and podiatrists."

The clinic is a subsidized service under Providence's community benefit. As part of a nonprofit hospital system, it is required to write off a portion of costs for care and medicines under the Affordable Care Act, whether patients are insured, underinsured or not insured.

"Providence goes above requirements because it is their Catholic mission to be steadfast in serving all, especially those who are poor and vulnerable," he said.

In 2022, the Inland Northwest Service Area of Providence provided $20 million in free and discounted care for uninsured and underinsured patients in Spokane and Stevens counties.

Because clinic staff listen and take time, patients consider the clinic is part of their street family. Given the distrust that is part of the survival mode of street life, Robert said it's important that people have someone outside of the street life whom they can trust and open up to.

"Our mission is to be ambassadors of trust, so patients disclose information to help in their treatment," he said.

He sees homelessness gain attention in political campaign seasons, when the homeless are easy targets.

Although Robert is on the group developing a collaborative effort to address homelessness, he challenges the original focus of its proposal on crime and public safety related to those experiencing homelessness. He urges a public- and population-based health approach.

As chair of the 1,400-member Spokane Homeless Coalition and member of the Spokane Continuum of Care Board responsible for allocating HUD funds, he has first-hand experience with the political narrative.

"Our move to adopt a regional authority challenges how politicians talk about homelessness," he said, emphasizing that local leaders need to rethink how they invest resources. "Innovation is key."

Because it is connected with Providence's Catholic roots, the clinic expresses God's healing love, he said.

"The wisdom of Jesus' steadfast love is ingrained in what we do. We take blueprints from the daily life of Jesus—washing feet, healing people and accepting them as they are," Robert said. "What better best-selling story to replicate and apply than the clinic's culture of actionable love expressed by taking time for the timeless."

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Copyright@ The Fig Tree, November 2023