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Housing is Healthcare: How a PCMH is Caring for NYC’s Homeless Population

March 14, 2018
by Rajiv Leventhal
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Care for the Homeless was able to apply Patient-Centered Medical Home standards across 14 health centers to enhance care quality for New York City’s homeless population

As of January 2018, there were more than 63,000 homeless people, including over 23,000 homeless children, sleeping each night in the New York City municipal shelter system, according to statistics from the Coalition for the Homeless. What’s more, there were an additional 4,000 homeless people on the streets of New York City, per recent data from the Homeless Outreach Population Estimate.

And when it comes to receiving healthcare services, it’s clearly been a struggle for all parties involved. On one hand, having stable housing is an obvious connection to being able to stay healthy. And on the other hand, from a healthcare cost perspective, homeless individuals are more likely to use ER services than members of the general public.

There are a fair share of organizations in New York City that help the homeless with healthcare issues, with one of those such organizations being Care for the Homeless, an institution developed in 1985 with the aim to meet the healthcare and social service needs of homeless people in the city. What separates Care for the Homeless from some other organizations of its ilk, however, is that it was just recently formally recognized by the National Committee for Quality Assurance (NCQA) as a Level 3 Patient-Centered Medical Home (PCMH). The New York City-based organization partnered with the Massachusetts eHealth Collaborative (MAeHC) to apply PCMH standards across its 14 sites.

The team-based PCMH approach gives each person who seeks treatment at Care for the Homeless a comprehensive care plan that is integrated across multiple providers at any of the organization’s health centers. Care for the Homeless’ service delivery model provides care at co-located host sites such as shelters and soup kitchens. Interdisciplinary teams visit these service sites anywhere from one to five days a week to offer certain primary care services; the system also has some behavioral/mental health and podiatry services.

What’s more, Care for the Homeless partners with other organizations, such as the Institute for Family Health, to directly treat patients at mobile health clinics across the city. Overall, the organization serves between 7,500 and 8,500 men, women and children, annually, in the Bronx, Brooklyn, Queens and Manhattan.

“We provide care to people during a very fragmented time in their life,” says Regina Olasin, D.O., chief medical officer at Care for the Homeless. “Our goal is to not just give them a medical home where they can turn to for care options, but to also provide a place that feels like a home—a warm and welcoming space where the providers know their names. When homelessness strikes, it affects more than a person’s current situation—it can expose them to major health risks with long-term ramifications. We aim to step in and help empower people with a path towards a healthier future.”

Indeed, Olasin says one of the core missions at Care for the Homeless is that “housing is healthcare,” adding that “If you look at all the data of people who are stably housed, they are doing much better on every single health parameter out there than individuals who are not stably housed.”

Undoubtedly, one of the major challenges with caring for the homeless is being able to follow them across the care continuum. As Courtney Beach, senior consultant at MAeHC puts it, “When serving a transient population with a unique set of needs, it is very difficult to track patients to ensure that they are utilizing the services or receiving information about their care.” At Care for the Homeless’ 15 sites, though, the EHR (electronic health record) allows for shared functionality, so that when a site is closed or when someone needs to be seen, the same medical record is available for all affiliated providers, and it enables the organization to provide 24/7 care with access to the EHR, says Olasin.

“A lot of the work we are doing is bridging care; the tragic piece to homelessness in New York City is that more shelters are needed to accommodate the needs of the people who don’t have access to affordable housing,” Olasin contends. “But with EHRs, we can work with health homes to provide bridging services to the next provider of care. So if someone is fortunate and leaves the shelter, we can connect [that person] with a health home and provide the medical information to the next person who is giving the care, with the [permission] releases that are obviously needed,” she says.

What’s more, through the use of the portal, the patient can have his or her own access with complete portability, as Care for the Homeless “web-enables” the population since 80 percent of individuals in homeless shelters have smartphones, explains Olasin. And once the organization’s mobile app gets up-and-running, she adds, the patients “will have access and portability to their health data that was provided during a period of their life when they were in a fragmented situation. And that’s incredibly valuable,” she says.

To this end, Olasin says that using the app could give patients the ability to make appointments with doctors and potentially use the mobile health service for telemedicine encounters. But she notes that one key issue is that these phones are in-and-out of operation for many homeless people who can’t pay their phone bills. “That’s a new type of barrier to care,” Olasin admits.

Partnering with MAeHC


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It's good to hear, that such help is provided. But still there are many people on the streets, not staying at shelters. There should be much more of sleeping places, not only to help those people (but of course is is the main reason) but also to keep generally high health standards in the cities. And to prevent some part of crimes, as well. Furnishing the shelters should not be very expensive, as there are many producers and intermediaries offering cheap furniture all over the US (actually the beds would be crucial). So it's good that there are some shelters, but we need more - this would be with a benefit for each of us.