Marcos Alvarez sat on the bed inside his dingy, one-room apartment in San Francisco’s Tenderloin neighborhood. He hadn’t been outside in months, he said. The streets made him panic.

“I’m scared to go out by myself,” said the blind, 62-year-old Salvadorean man, who speaks only Spanish. “It’s not nice to go out in this neighborhood. Here inside I feel calm. I feel safe.”

Alvarez’ fears weren’t new to outreach worker Andres Lozano. For weeks he’d been visiting Alvarez as part of a program run by the Tenderloin’s Curry Senior Center. The program, called Peer Outreach, sends trained “peers” to build relationships with low-income seniors who have become socially isolated. The seniors often have trouble connecting with others and, in some cases, leaving their homes. It could be because of a physical disability, mental disorder, substance abuse, language barriers or simply because they’re nervous about braving the Tenderloin’s notoriously crime-ridden streets.

Peers are mostly seniors themselves, trained to do outreach and paid about $16 an hour to visit the isolated Tenderloin residents, said program manager Daniel Hill. Their job is to try to connect the clients with services they need and, just as importantly, to provide companionship. That could mean taking them to the Curry Senior Center’s dining hall for a meal, bringing them to a social event such as a poetry reading, or just spending time with them in their homes playing card games or watching old Westerns, Hill said. Typically the peers visit once or twice a week for a couple of hours at a time.

The program launched in 2015 and uses state funding managed by the San Francisco Department of Public Health. Eight peers work with around 30 to 35 isolated seniors, some identified by the Curry Senior Center itself, others referred to the center from outside agencies. The program is a pilot, although its funding is authorized through mid-2019, Hill said. The budget is about $235,000 a year, but the program would cost significantly less over the long-term because about half of the spending is related to start-up costs, he said.

A Musical Bond

When Lozano visits Alvarez, the two play music together. Lozano, 52, is a guitar player, and Alvarez used to make his living playing keyboard and singing in San Francisco’s subway stations. The music helps Lozano bond with Alvarez. Over the few weeks he’d been visiting, he said Alvarez had begun to open up more and seemed to be gaining self-confidence.

“It’s more than just case management. It’s company,” Lozano explained. “I go there to see how he’s doing, ask him how things are going. It’s more of a visit, like a friend.”

Alvarez said he stopped going out because his once partial blindness has become almost absolute. He’s also been mugged, threatened and made fun of in the streets, he said. Alvarez said he survives because a friend sometimes brings him food and money.

Lozano has been trying to coax Alvarez out of his self-imposed isolation. After playing a few Latin ballads together on a recent visit, Lozano leaned toward him, hands clasped. How would he like to do a musical performance with other seniors at a nearby apartment building? Lozano asked.

Alvarez squirmed uncomfortably.

“I’ll try to go,” he said.

“I want to be able to count on your participation,” Lozano insisted gently.

“Well, I might come and watch. I don’t want to sing,” Alvarez said.

A Time-Intensive Endeavor

It can take weeks to gain a client’s trust, Hill said. He recounted the story of an elderly woman who refused to let a peer into her apartment for over a month. Each week he’d go back and she’d open the door a few more inches. Finally, at Christmas, he brought her gifts and she invited him in. Hill said some seniors don’t leave their apartments, while others are hard to find because they’re out wandering the streets.

Peer Outreach is also partnering with UC San Francisco to formally measure the impact of the program on the senior’s wellbeing. Until that research is completed, Hill said the impact is mainly anecdotal.

“Just sitting here and hearing the stories that the peers bring in about their relationships to their clients—some of them are heartbreaking stories of individuals so alone, and sometimes they’re so heartwarming of what the peers are doing,” Hill said. “We see how important it is and we hear how people’s lives are being changed.”

In addition to spending time with Alvarez, Lozano pays weekly visits to Luis Bolaños, a 73-year-old Guatemalan man who lives in an even smaller one-room apartment a few blocks away. Bolaños suffers from diabetes and depression. He gets around in a wheelchair, although he said he doesn’t like going out because he was once hit by a “crazy man,” and another time a drug dealer threw a bicycle at him. The senior said he has no family in the United States other than a grandson who lives in Los Angeles whom he rarely sees.

During one visit, Lozano chatted with Bolaños about his grandson and music. He then asked him whether he needed help getting to the doctor, offered to bring him soap, new pants and a radio, and put in a call to get Bolaños set up with a free cell phone. Lozano then walked with Bolaños to the Curry Senior Center to help him renew an ID card he needed, and sat with him in the dining room eating lentil soup. Peers can access supplies donated to the senior center, or if the item is inexpensive and a necessity—such as a dustpan or mop—they can fill out a request form to purchase it for the client. For cell phones, they connect with a government agency that supplies them.

When it was time to leave, Bolaños looked up at Lozano.

“Thank you,” he said. “I hope I didn’t bother you, but I need you. That’s the way it is. I’m very grateful.”

Back at Alvarez’ apartment Marcos became bolder as the visit progressed. Shy about playing his music at first, he was soon showing off a volume of songs he’d written and singing the Latin genre of music Cumbia in a powerful, booming voice. The songs were about his life: hardships he’d experienced growing up in El Salvador and a love he left behind, he said.

Finally, it was time to go. As Lozano headed toward the apartment entrance, Marcos called out to him.

“Well, if it’s possible to participate in the event, just give me a couple weeks notice,” he said.

Lozano smiled triumphantly to himself.

“Of course, sir,” he called back.

As the door closed, Marcos’ keyboard started up again.

Although he didn’t end up participating in the first event Lozano planned, Alvarez did perform songs with a guitar for other residents in the lobby of his building early in May, the peer said.

“He played more than one song, he was actually the star,” Lozano said. Residents “were blown away. One woman went up to him and, although she didn’t understand what he was singing, she gave him a kiss on the forehead.”

The performance boosted Alvarez’ confidence and made him feel he has a skill he can share with people, Lozano said. The peer is hosting another musical event at a different residence next week and has invited Alvarez again.

“Hopefully he’ll show up,” Lozano said.