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Healthcare for the Homeless Hits the Road (Suitcase clinic initiative)

By: Jordan Pye
Posted: October 19, 2011

PHOTO: JMU students treating manDuring summer 2011, medical personnel and students began making unconventional “house calls” to bring primary care to Harrisonburg’s homeless through weekly on sight clinic visits to area shelters.

Statistics estimate there are more than 300 homeless living in Harrisonburg and Rockingham County, and the city school system reported at least 128 homeless students in 2010. This demographic grew by nearly a third since 2009, and the US Census Bureau recently named Harrisonburg the No. 1 city in Virginia for uninsured persons. According to shelter managers, obstacles the homeless face in receiving health care include basic problems such as lack of transportation, insurance and funds for co-payments. Many seek regular care in the emergency department , which is ineffective and now located further away from shelters on the new Rockingham Memorial Hospital campus.

To meet this need, the Healthcare for the Homeless, “Suitcase Clinic” collaboration between James Madison University’s Institute for Innovation in Health and Human Services and the Harrisonburg Community Health Center takes a new approach to this issue by bringing care directly to this vulnerable population. Each week, nurse practitioner Tara Haley and medical case manager Amy Layman of the HCHC will bring equipment to shelters in a wheeled suitcase, treating homeless clients and referring them to community resources for further care.

“Generally people have been very receptive of our on-site presence, and we have no lack of patients who would like to be seen,” Haley said. “Their health needs don’t end with the diagnosis, [because] their life circumstances make their health care a complex, layered situation.”

Haley and Layman began seeing patients at Mercy House, , First Step and Our Community Place in early June and added trips to Salvation Army in August. They plan to expand visits to Elkton and the seasonal Harrisonburg and Rockingham Thermal Shelters (HARTS) that run from October through April. The duo is equipped to perform physicals and lab testing, and manage acute illness and chronic health issues like diabetes or hypertension. Clients are referred to the Community Health Center to manage their care long term, and for services like immunizations or women’s health care. As clients on file with the HCHC, Layman helps patients determine their eligibility for local, state and federal programs like Medicaid, Medicare or veterans’ benefits, and helps them get reduced price prescriptions.

“People are chronically homeless for good reasons, sometimes they need someone to be supportive, and an advocate who can help them  walk  through the system,” Associate Director of IIHHS and project director Jane Hubbell said.

In 2009, Hubbell and JMU nursing professor Dr. Linda Hulton joined like-minded community members to form a Healthcare for the Homeless Coalition with JMU and Eastern Mennonite University nursing departments, the Harrisonburg Housing Authority and homeless shelters. Their aim to reduce barriers the homeless face in receiving care developed the mobile “suitcase clinic” to visit homeless clients and help them become long-term patients at the Community Health Center.

The group looked at factors contributing to the problem of homelessness, especially the inability to access health care for medical, psychological or substance abuse issues. One of the biggest difficulties the homeless face is affording prescriptions, because a $4 generic medicine can be too expensive for patients without jobs or health insurance. By helping the homeless navigate the system of medical management services, they could improve their health, break the poverty cycle and move a step closer toward permanent housing.

The coalition proposed that for the size of the community, a full-time nurse practitioner, medical case manager and a part-time data analysis and support position would be enough to meet the needs of some 175 homeless clients, and reduce unnecessary emergency room visits. Although the group is still seeking funding for the estimated operating budget of $200,000 a year, the program is considered a permanent part of HCHC operations and the 2011-2012 academic year will allow for further development and evaluation of its effectiveness. So far the program has received funding from the City of Harrisonburg, Rockingham Memorial Hospital, United Way and Columbia Gas, and Merck awarded the program a $50,000 grant at the beginning of the summer. Another goal is to collect donations to help cover patients’ medication costs.

“We believe in this project, so let’s do what we can with the money we have,” Haley said.

JMU Nursing has long volunteered with the shelters, and past nursing students put on health fairs to provide   haircuts, socks,  bus passes and perform screening tests. The weekly mobile clinic visits would provide first-hand experience for nurses in training, and this fall the faculty will flesh out plans to further involve undergraduate and graduate-level nursing students, as well as other programs like social work.

“At first students are a little afraid of what they’ll face, but then they warm up to it and it touches their hearts,” nursing Professor Dr. Linda Hulton said.

Hubbell said she sees IIHHS as the hub of the wheel in the collaborative effort, connecting the university’s faculty and young people to ways they can meet the community’s needs.

“The goal is to graduate students with a broad understanding of depth and breadth of the health and human service field, because the system involves lots of professions,” Hubbell said. “When you look at a problem with this  broader len your work becomes more powerful”.