Catching Homelessness: A Nurse's Story of Falling Through the Safety Net

by Josephine Ensign

At the beginning of the homelessness epidemic in the 1980s, Josephine Ensign was a young, white, Southern, Christian wife, mother, and nurse running a new medical clinic for the homeless in the heart of the South. Through her work and intense relationships with patients and co-workers, her worldview was shattered, and after losing her job, family, and house, she became homeless herself. She reconstructed her life with altered views on homelessness―and on the health care system. In Catching Homelessness , Ensign reflects on how this work has changed her and how her work has changed through the experience of being homeless―providing a piercing look at the homelessness industry, nursing, and our country’s health care safety net.

Genres: Nonfiction, Memoir, Health, Biography, Medicine, Politics, Poverty

240 pages, Paperback

First published August 9, 2016

About the author

Josephine Ensign is a professor at the University of Washington, Seattle, where she teaches community health, health policy, and narrative medicine. A graduate of Oberlin College, the Medical College of Virginia, and Johns Hopkins University, she has been a nurse for over thirty years, providing health care for homeless and marginalized populations. She is an alumna of Hedgebrook and the Community of Writers at Squaw Valley. Her essays have appeared in The Sun, The Oberlin Alumni Magazine, Pulse, Silk Road, The Intima, The Examined Life Journal, Johns Hopkins Public Health Magazine, and the nonfiction anthology I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse, edited by Lee Gutkind. Catching Homelessness is her first book. She lives in Seattle. Her first book, Catching Homelessness: A Nurse's Story of Falling Through the Safety net was published in 2016. It was named the American Journal of Nursing 2017 Book of the Year for creative works.

Reviews

[Ashley · Rating 3 out of 5]

This is 2.5 stars for me, but I’m giving it three starts because of the first 150 pages of the book. However, I think the title is misleading, because this is much, much more about the true story of Ms. Ensign’s experience working in a clinic that served low income and homeless individuals in the mid-late 80s. That story is interesting, well-written and raises some great questions, but it is not the story that I think the blurb and the title suggest. Some spoilers below.

The first 150 pages or so are fascinating. Ms. Ensign opens this clinic with a grant, and runs it as the sole clinician. She is also the wife of a Christian who is pursuing seminary school, so she also has these expectations put upon to her to be a ‘good southern Christian woman.’ Reading about her patients, as well as her own awakening to what she wants in her life (spoiler alert: it isn’t to be with her husband) brings up so many great questions to pursue further. At one point the church becomes even more involved, reprimanding her for her counseling style with women who become pregnant out of marriage and people who have AIDS.

Ms. Ensign does end up without quality housing, but I find it odd that she doesn’t talk about that much. She lives in a storage facility on a camp her parents own, and apparently also lives in her car, but most of that is mentioned in passing. It feels almost like she ran out of steam, or felt that she didn’t want to reveal too much about that time in her life, yet the book was supposedly meant to be the insight of someone who has both served the homeless and experienced homeless herself. It just feels that the connections are missing. Especially because at one point she is working three jobs and then miraculously can just decide to turn one of those jobs into full-time work so she can have health insurance. And then … she moves to Seattle. We don’t learn why, or how that happens, or even when. It just feels so disjointed for the last 50 pages or so, and that bums me out. As this is Ms. Ensign’s first book, I think part of the blame lies with her editor.

Homelessness is such a huge issue in cities right now, and there are so many competing ideas about the root causes and the ways to support the individuals experiencing it, so I had such high hopes that this would be discussed deeply in this book. But it just wasn’t. And this seems like a huge missed opportunity.

Ms. Ensign now teaches at the University in my town, and is instructing students in the school of public health. In fact, this book was chosen as the one that incoming master’s students will be reading this fall. Unfortunately, there is an odd two- or three-page stretch of what I view as anti-feminist judgment of sex work (and the unironic use of the words “politically correct” as though that is a bad thing, which pisses me off) and those who provide non-judgmental health care to sex workers, so I’m saddened that young folks will be reading this book and being exposed to that thinking.

It is possible my opinion will change after book club this week, and if so, I’ll come back and amend this review, but for now, I just can’t recommend this book.

[Chana · Rating 3 out of 5]

It is hard to review this book as it is a very personal story in many ways. That I don't feel I can comment on. But the work she did with homeless people, her humanity, her honesty, her struggles in working with this difficult population, well I had nothing but admiration for her. I was sorry that her struggles with her religion and her marriage caused her the problems that they did. She still works in public health and has many years of working with the homeless to her credit. Too bad that homelessness has only gotten worse in recent years.

[Kevin · Rating 2 out of 5]

There were a few standout sections, like a brief one in which Ensign gives a cursory description of the political movements around homelessness on both sides and another in which she describes trying to keep her composure while treating a festering wound. It was a semi-interesting read, but overall I found it lacking on two fronts. 1) Ensign's writing did not seem introspective enough about her own experiences and choices. I was left with many unanswered questions regarding her family life, the ways she conducted herself with patients and colleagues, and her motivations. She gives Cliff's Notes on her childhood and family which, as they contribute to her own work life and homelessness, feel lacking. They must have been bigger influences than she shares here. 2) There's a big question that Ensign touches on in the book but did not explore to my satisfaction, and that's the "pearls before swine" metaphor she brings up - that homeless will most likely always be with us and healthcare outcomes for these folks will always be disadvantaged. (She introduces it more as a question of what kind of impact care is really doing for these folks, or how much they appreciate it.) This is ripe territory, as is the issue of provider burnout, but these don't get the treatment they deserve. I found the episode in which Ensign describes her own homeless as lacking, too. She has the rug pulled out from under her by a religiously-zealous system, for sure, but she's upwardly mobile and highly-trained. Her writing doesn't really explore why she let things go, and the ease of her decision to get out of homelessness (as easily as that, prompted by a medical issue for which she wants insurance) is not self-aware enough in a book mostly about treating folks who are persistently homeless. This was a pleasant read. Ensign has an easy, straight-forward style, but it's missing some of the personal exploration and thoughtfulness I like from memoir.

[Martina Clark · Rating 5 out of 5]

I found this book both interesting and educational. I learned a tremendous amount and was moved by the author's story which illustrated just how quickly one's life can unravel. Highly recommend!
Additional Review for Women's History Month 2023:
In 2013 I had the good fortune to attend The Community of Writers' nonfiction workshop near Lake Tahoe where I met a number of extraordinary women writers. Among them is a woman named Josephine Ensign and this is her story.
In the 1980s as our homelessness crisis will fulling emerging, Ensign worked in a clinic serving marginalized individuals in the south. She worked tirelessly to help her clients and found her world shattered by the experiences of their realities.
Eventually, she too fell through the cracks and found herself homeless and separated from her former life, her family, and the safe comfortable world she'd once inhabited.
But, although rarely told, she like many other unhoused individuals found an inner strength to get back on track and change the world, both for herself and for others.
She has since gone on to lead an extraordinary life as an educator, nurse, and advocate for changing our public health care system. I am always in awe of her work and her unwavering dedication to serving others.
Catching Homelessness is more important today than ever before as our unhoused population in the United States - the richest country on the planet - continues to grow at rates this woman finds incomprehensible.
We should all take the time to learn more about this crisis and what each of us can do to make a difference in the lives of the unhoused and all who fall through the safety nets in America.
I hope you'll enjoy this testimonial for living through seemingly insurmountable experiences and coming out ahead. Learn more. Do more. Read more!

[Katie · Rating 3 out of 5]

An interesting read, but not what I expected. The author spends the bulk of the book detailing a free clinic in the late 1980's. Her decline into "precarious housing" is brief, and so is the description of how she pulled herself out of it. I would have liked to learn more about these experiences, as well as how her views on homelessness and healthcare for homeless evolved.

[Rachel B · Rating 1 out of 5]

1.5 stars

I was very disappointed with this one. Firstly, the publisher's description claims this book is about a nurse who "falls through the safety net," becoming homeless after she "loses her job, family..." Right from the get-go, this is just false information. Ensign doesn't "lose" her job, she quits. She doesn't "lose" her family, she leaves them. And to be quite frank, she barely even becomes "homeless." She really only qualifies for that description if homeless is equivalent with houseless. (I don't believe that it it.)

She has a self-absorbed, arrogant attitude that reminded me of Cheryl Strayed in her book Wild. (You can read my review for Wild here.)

Actually, very little of the book even tells Ensign's story. Most of the book was focused on her work with patients in a clinic for the homeless. I thought these little snippets were good but, even so, she never explored either others' stories or her own to the point where this could be seen as a truly helpful resource.

In addition, there is some brief sexual content, profanity, and a lot of bitterness/rage toward religion, particularly Christianity.

[Laura Singleton · Rating 2 out of 5]

A very big letdown. She did not fall through the safety net. She quit her job, didn't live with a friend she could have because she was too proud to ask, didn't live with her parents when they offered, and had apartments (though filthy, poor ones) as well as a shed on her parents' property. She was not homeless, she was houseless (or "marginally housed," as she puts it). Major kudos to her for loving the homeless clientele and being called to protect them. Also, there is an extremely high BF (Barf Factor) for those sensitive. I'll warn you: p. 52, lice and crabs. P. 88, maggots. P. 188, teratoma, or "monster tumor," which contains TEETH and vestiges of an embryo. OH MY GOD, GAAAAAAGGG. She totally glossed over her own experiences being houseless, as well as how she managed to get her life back on track.

[Ben · Rating 1 out of 5]

Some random thoughts:
* The author was never actually homeless, just wasn't living in a proper house.
* The author gave up everything she had and then whines about having nothing.
* The author barely gave any details behind these decisions as most of the book was focused on her work as a nurse in a free clinic (interesting, but not what the title suggests the book is about).
* Appendix A is one of the dumbest things I've ever read and I hope no one takes it seriously.
* The author has a huge problem with "men", Christianity, and "the south" and doesn't hide it.
* The author has practically no sense of humility, deciding (what feels like on a whim) to go to Johns friggin Hopkins when at her lowest.
* Even though I couldn't stand the author, I finished the book just so I could get some more interesting stories about the patients.

Man, I'm glad this book is over.

[Elaine · Rating 4 out of 5]

Author/nurse/advocate Josephine Ensign weaves a moving personal story with a frank look at struggling services for people who have no homes, no place to sleep, bathe, or just be in private. Her compassion for the people she is treating -- often abandoned, abused and marginalized, sometimes by the very agencies that are purporting to help them -- shines through. I do agree with other reviewers who say that the publishers' blurb is very misleading. The author's experience (where she has other options for shelter -- her friend, her parents, etc. ) is very different than most of the chronically unhoused people who frequent her clinic. Still, people should be allowed to define the terms that describe them for themselves.

[D Reed Whittaker · Rating 3 out of 5]

Not sure what I was expecting - a road-map to homelessness? This is an interesting memoir, but fell short of my expectation - how does one become homeless. While several of the vignettes are insightful, I was expecting more. My major take-away is we are not making progress. Much of what she describes in 1980s Richmond, VA is still the case in 2018 Salt Lake. Her focus is medical care, I would've like more insight into housing and employment. If at all interested in homelessness, you won't be wasting your time reading this. She's a good writer. It's a worthwhile book, just not what I expected. Enjoy.

[Ardina · Rating 4 out of 5]

I really enjoyed this memoir.

Parts of it felt a bit disconnected - w certain details left out. I agree with other reviewers that the title is misleading; there is not much time/space devoted to the author’s specific experience of homelessness. I didn’t mind this though and actually enjoyed her writing on her experience as a healthcare provider working in the “business” of the homeless. I appreciated Ensign giving historical context for a lot of the ideas she discussed. I also thought she did a great job with geographical context, painting a very vivid picture of Richmond, VA.

[Anne Bourne · Rating 5 out of 5]

Interesting perspective

Drawn in from the very beginning. Through her eyes we get a vivid picture of homelessness. I loved reading about Richmond and how different a place and time can be from now. Somethings never change and some change completely. Thank you for sharing your personal journey.

[Echo · Rating 3 out of 5]

I read this quickly - it was very easy to read and engaging enough. However I am on the fence about how it sits with me. It seems to be as hard to figure out my feelings about this book as it is to work out the situation of homelessness in our country.

[Jeffrey · Rating 5 out of 5]

Heartfelt

A must read for aspiring nursing students with a focus on compassion through life's unforseen circumstances. A testimony of will power. Thank You for sharing your thoughts and experiences through this book.

[Laurie Barkin · Rating 4 out of 5]

The author's experience is an eye-opener for dealing with patients in the same situation. Bravo.

[Garry Cooke · Rating 5 out of 5]

Intense

The stories she told about her struggles with not only helping those without homes and her own struggles were quite touching.

[Josephine Barrett · Rating 5 out of 5]

Very personal, Ensign leads by example while seeming to demonstrate empathy. She doesn't blame her audience, which is a vibe sometimes given off by books.

[Jennifer D. Munro · Rating 5 out of 5]

Stunning book. Compelling exploration of homelessness, the South, patriarchy, nurse practitioners, and one woman's journey to discover her true self (that sounds like an "overdone theme" we see too often, but I can't think of a stronger example of a woman giving up everything, and I mean EVERYTHING, to become an independent person [while still helping others!]; most of us would not have had the courage or fortitude). I stand in awe.

[Julene · Rating 5 out of 5]

Josephine Ensign was an early graduate of a Nurse Practionier program in Virginia, the heart of the Bible Belt states. She came from a religious family and felt called to be one of the "shining points of light" of that generation. She started a clinic from the ground up and for three years it grew. She was eventually squeezed out by the fundamentalist organization she worked for and the powers in the state that did not allow women to have the kind of power she had taken in setting up and running a clinic. They accused her of providing prescriptions and put her under surveliance. For the organization she was too lenient towards those with AIDS, and she could not give out information on where to get an abortion. I paraphrase her response to a question at the talk where I heard her read, "the dogmatism of beliefs held by the church got in the way of providing public health."

This book examins health care from a public health perspective and gives an excellent overview of the many problems our country faces to provide housing and health care to the growing population with these needs. It started in the Reagan/Bush years when Reagan closed the institutions for the mentally ill and the problems when they were sent into the world with not enough services or programs in place. She shows how the southern states that are not opening their Medicaid to the Affordable Care Act plan continues to perpetuate the problems growing in our country.

And, she tells the tale of her own 'catching homelessness' and the utter dispare she sunk to, however, as a white educated woman she had innate resources, she had these privileges to help her pull herself up and recreate her life, which she had done here in Seattle. The final chapter "Greyhound Therapy" is a testament how important it was to leave the state she was born in to start over. She has a life that continues to give and be a point of light that is desperately needed. Everyone should read this book, and I'm glad that the University of Washington is supporting her book; her book will be read by each student in all public health programs, this will lead to more discussion and many new points of light coming on to change our society so people can get the health care and housing they need.

[Curtis · Rating 4 out of 5]

The homelessness epidemic in the United States evokes many different reactions from people. What did they do to end up homeless? Why don't they just get a job? How can I help? Should I help? Could this ever happen to me?
The answers to those questions are as varied as there are people to ask them. But one thing is clear, the number of homeless in our country is increasing. And we need to think more critically about how we, as individuals and as a society, respond to it.

In Catching Homelessness, Josephine Ensign, a nurse practitioner, chronicles her work with the homeless. She discusses why she initially got involved, the people and issues she saw, and what she's learned about trying to help. She also talks, rather frankly, about her own period of homelessness. When she started working with the homeless, she was one of those who thought it could never happen to her. Her story and experience not only provide readers with a firsthand look at helping the homeless, but also with the voice of someone who has been there. Both sides of the coin are reflected here.

To say the subject is heavy would be an understatement. Not because this is a book that left me near tears on every page; it's not like that. But "heavy" just doesn't capture the rawness and reality of the stories contained in this book. Even if you're someone who works with the homeless or already has your eyes "open," I highly recommend picking up this book. It's honestly a quick read, but it's very powerful. I find myself still reflecting on it a few days after I finished it. And I expect I'll continue to think about it for some time to come...

[Margaret Adams]

Although the blurb and tagline for Ensign's "Catching Homelessness" highlight her own personal experience of "falling through the safety net," I found her descriptions of working as a new nurse practitioner and the sole provider at the newly opened Street Center in Richmond in 1986 much more compelling. I heavily dog-eared my copy during the first two thirds of the book--it felt like every other page held an articulation about community health (and being a nurse practitioner) that really resonated with me. From her struggles with work/life boundaries, to her criticisms of some of the educational approaches of nursing school, to her observations regarding the power dynamics surrounding "charity care" in the United States, this book is a great read for anyone interested in health care models and the "underserved." Writes Ensign, about halfway through the chronicle of her own unraveling, "by now I realized that safety net health care in our country was only tolerated when it was contained as charity care, volunteer-type health care that made volunteers the agency behind the care feel good about their generosity. It wasn't tolerated when charity care challenged the status quo."

[Janci · Rating 4 out of 5]

The beginning of this book is very good. I volunteer at a center for homeless and so I appreciated the insights. The parts about the culture of Richmond at that time were interesting as well. As a committed Christian in a large northern city, I wondered if the stereotypes of Christianity in the South were true. Sounds like they were, at least for this person at that time. Too bad, my church manages doubt in a completely different manner. I just have to ask, "Where was God in all this?" He was there but no one knew.

The part about the author's own homelessness was a bit garbled to me. Still, it added to the picture and I was glad she included it. Actually, I thought the book would be more about her experiences. I did not realize other people's stories would be included.

[Denise · Rating 2 out of 5]

I was the winner of a free issue giveaway sponsored by the author. Having worked in community mental health for almost forty years, I was intrigued by the book's premise. When discussing her patients, politics and the issues of homelessness the book rang true. However, when it came to her personal narrative, I wasn't sure what to think. To say she fell through the safety net seemed a bit disingenuous considering the choices she made. Yes, her struggles were real and I'm pleased she was able to survive and succeed with her life.

[BETTY SHEREN · Rating 4 out of 5]

I won this book as part of a giveaway from goodreads. At first I felt it was hard to get into, but I kept reading. I would put it down then go back to it again in a few days. I am so glad glad I kept trying to read this book. Once I got going, I couldn't put it down. I felt it was a touching story that o many could relate to. It really shows that bad things in life can happen to anyone . But how we handle things throw our way can help in overcoming lifes stumbling blocks. I recommend this book to others.

[Judy · Rating 4 out of 5]

appreciate the author's personal reflection and journey to her authentic self

[Kristina · Rating 3 out of 5]

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[Sue]

I was asked to write a review, but I never received it from Good Reads!