When you first meet Edith, you are immediately struck by a radiant warmth—a sense of joy that seems to defy her physical circumstances. Dressed in a cozy hoodie and wearing a floral-decorated headband, she sits in her adjustable hospital bed, oxygen tube in place, greeting visitors with a genuine, welcoming smile. Her home, a light-filled, first-floor apartment in San Francisco’s Potrero public housing development, is a testament to resilience. But for Edith, this tranquility is a relatively recent development. Living with the daily challenges of Multiple Sclerosis (MS) and severe asthma, Edith’s journey from isolation to a supported, dignified life is a poignant case study in the efficacy of targeted, compassionate social advocacy.
The Turning Point: Bridging the Gap in Care
Edith’s story is inextricably linked to Raven McCroey, a dedicated staff member of Shanti’s Peer Advocate Care Team (PACT). As the Resident Services Coordinator at 1101 Connecticut Street, a building that opened its doors in 2019, McCroey serves as a vital bridge between vulnerable residents and the complex web of public health resources.
For many living in public housing, the greatest obstacle to health isn’t just the disease itself—it is the navigation of the system required to manage it. When McCroey first met Edith, the disparity between her medical needs and her quality of life was stark. At that time, Edith was living on the second floor, spending her days in a state of near-constant exhaustion, often falling asleep on her living room couch because her bed was physically uncomfortable and medically inadequate. She was essentially trapped, not just by her MS, but by an environment that did not account for her limitations.
"Before, I was abandoned," Edith reflects, looking back on those days. "Now, I have a lot of people who care. After meeting Raven, I feel like I have a life."
Chronology of Care: A Partnership Built on Trust
The transformation of Edith’s living situation did not happen overnight. It was the result of a deliberate, eighteen-month process of relationship-building and persistent advocacy.
Phase 1: The Tuesday Routine
The foundation of the support system was consistency. For a year and a half, McCroey made a point of delivering food to Edith every Tuesday. In the world of social work, these moments are rarely just about the delivery of goods; they are about the delivery of presence. Through these weekly interactions, a bond of trust was forged. It was within this safe space that Edith finally felt comfortable enough to share the true extent of the barriers she faced, moving beyond superficial pleasantries to reveal the daily struggle of living with chronic illness.
Phase 2: Systemic Integration
Once the scope of the problem was identified, McCroey initiated a series of referrals that changed the trajectory of Edith’s care. She introduced Edith to a nurse from the Department of Public Health Wellness Center. This connection proved pivotal. The nurse facilitated the delivery of essential medical equipment—including the remote-controlled hospital bed—that allowed Edith to manage her asthma and MS symptoms with far greater autonomy. Simultaneously, the team coordinated daily caregiver support, ensuring that Edith had help with morning routines, such as getting dressed and preparing breakfast.
Phase 3: Structural Advocacy
Recognizing that the physical environment was a major barrier to Edith’s health, McCroey advocated for her relocation to a first-floor apartment. This move was not merely a change of scenery; it was a fundamental shift in Edith’s ability to interact with the world. The proximity to the exit and the ease of access allowed her to maintain a level of mobility that had previously been impossible.
Phase 4: Crisis Intervention
The necessity of the PACT model was underscored recently when Edith spent time in a nursing home. When she felt the care provided did not meet her needs, she reached out to McCroey. McCroey’s subsequent intervention—visiting the facility and advocating on Edith’s behalf—highlighted the "advocate" aspect of the PACT program. It serves as a reminder that for many patients, the greatest medical tool is not a prescription, but a voice.
Supporting Data: The Impact of PACT and Resident Coordination
The PACT model, operated by the non-profit organization Shanti, is built on the philosophy that social determinants of health—housing, nutrition, and social support—are as critical as clinical interventions. In San Francisco’s housing developments, where residents often face a high burden of chronic illness, the role of a Resident Services Coordinator (RSC) is vital.
According to industry standards in social work, proactive resident services can reduce emergency room visits by as much as 30% for high-risk populations. By providing "care navigation," individuals like McCroey prevent the "revolving door" phenomenon, where patients are discharged into environments that do not support their recovery, only to return to the hospital weeks later.
Edith’s experience mirrors this data. By stabilizing her living environment, the PACT team reduced the need for crisis-level interventions, allowing Edith to move from a state of "survival" to one of "living." Her days are now spent reading on her phone, watching movies with her daughter—who is studying interior design at SF State—and enjoying the sunlight that fills her apartment.
Official Perspectives: The Philosophy of Shanti
The Shanti Project has long been a pillar of the San Francisco social services landscape. Their approach is rooted in the belief that "every person deserves to be treated with dignity and respect." The PACT program specifically targets the intersection of housing and health, recognizing that public housing residents are often overlooked by traditional medical systems.
When an advocate like McCroey engages with a client, they are not just checking a box; they are performing a holistic assessment. They look at the apartment, the mobility, the mental health, and the social isolation. The "Peer Advocate" title is deliberate—it suggests a partnership rather than a hierarchy. By positioning the advocate as a teammate, the organization empowers the resident to take charge of their own health journey.
Implications for Public Health Policy
Edith’s story holds broader implications for how municipalities should handle public housing. The model of embedding services directly into housing developments—rather than forcing residents to seek out disparate agencies across the city—is proven to be more effective.
1. The Necessity of Holistic Case Management
Public health officials are increasingly recognizing that the "medical model" (doctor-patient-medication) is insufficient for patients with complex, long-term disabilities. The inclusion of social workers and resident coordinators in the housing equation ensures that medical treatments are actually feasible.
2. Combating Social Isolation
Edith’s comment—"Before, I was abandoned"—speaks to the epidemic of loneliness among the chronically ill. When residents feel seen and heard by a consistent, caring professional, their mental health improves, which in turn boosts physical immune response and recovery rates.
3. Cost-Effectiveness
While funding social service positions like those within the PACT program requires upfront investment, the long-term savings are significant. By preventing unnecessary nursing home stays, reducing emergency room reliance, and helping residents maintain independence, these programs lower the overall cost of public health burdens on the city.
Conclusion: A New Chapter
Today, Edith’s room is a sanctuary. It is filled with the equipment she needs to thrive—the walker, the wheelchair, and the adjustable bed—but it is also filled with the things that make life meaningful: books, movies, and the presence of her family.
The success of Edith’s story is not a miracle; it is the result of a system that works when it is properly funded and staffed by compassionate, persistent professionals. As San Francisco continues to navigate the complexities of public housing and the needs of its most vulnerable citizens, the PACT model stands as a beacon of what is possible. It serves as a reminder that with the right support, the "barriers" that seem insurmountable—the stairs, the illness, the isolation—can be dismantled, one Tuesday at a time.
For Edith, the change is simple but profound: she is no longer just a patient waiting for the day to end. She is a woman with a life, a voice, and a community.
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