Street Medicine makes house calls to homeless
Feb 14, 2017
Allentown, Pa.-based Lehigh Valley Health Network’s (LVHN) Street Medicine program includes clinics in a number of area shelters and soup kitchens, a street medicine team, and an inpatient/outpatient consult service that has helped reduce emergency department (ED) visits while increasing the number of insured homeless residents.
The program’s success in getting better care and coverage to Lehigh Valley’s homeless population was noted in a Nov. 29 AHA task force report on ensuring access to care in vulnerable communities. The report, “Ensuring Access in Vulnerable Communities,” cited LVHN’s street medicine as an example of how a health system is addressing the social determinants of health to help remain viable within the communities it serves.
The program brings free basic medical care, including medications, diagnostic studies and laboratory tests, to homeless residents through clinics set up in shelters and soup kitchens and on the streets in Bethlehem, Easton and Allentown – the Lehigh Valley area that was once a hub of the nation’s steel industry.
“For various reasons, they can’t access care the way other people do,” says physician assistant and Street Medicine director Brett Feldman, who launched the program three years ago. “We visit them in the shelters and visit the camps under the bridges to deliver as much care as possible on site.”
He and his team of physician and nurse assistants and community outreach workers provide a variety of treatments for ailments that include hypertension, diabetes, infectious disease, frostbite and dehydration. The team sees about 125 patients a month.
Feldman’s work also led to LVHN developing and piloting a screening tool used in the ED to better quantify the local homeless population and help direct more resources for their care and follow-up treatment and services.
“We start by addressing basic needs – shelter, food and safety,” Feldman says. Then the team tackles what he says are the next set of challenges – homeless residents’ lack of health insurance, transportation and trust in health care professionals.
Feldman, who visits homeless camps with a backpack filled with medical supplies, views street medicine as something like a “tool of diplomacy.” He says homeless residents see his stethoscope and understand “that I am there to heal them whether it’s physically or emotionally or sometimes spiritually.”
In addition to caring for their medical needs, he helps refer them to social workers. Or he may explain how they can get a photo ID or a government-subsidized phone so they can seek employment and get back on their feet.
The program’s consult service helps ED and hospital inpatient staff identify barriers to care for homeless patients. If a homeless patient comes into the ED or is admitted into the hospital, staff can contact the street medicine consult service. A member of the street team will see the patient in the ED and establish a relationship with them. “This is key to establishing trust with them on the street,” Feldman says. He says the team will do about 25 patient consults a month.
While patients are in the hospital, ED or inpatient staff give them information on community resources, like homeless shelters, food pantries, food stamp programs and health insurance. Patients also are connected to a primary care physician.
The service follows up with homeless patients wherever they go when they leave the hospital, whether that’s under a bridge or in a shelter, Feldman says. “If they are in one of the clinics, they see us,” he says. “If they are on the street they see us. We are the most stable thing in their lives.”
At Lehigh Valley Hospital, the largest of LVHN’s three hospitals, the street medicine program last year helped reduce 30-day readmission rates among homeless patients from 51% to 13%. Also, the rate of insured homeless rose from 24% to 73%.
LVHN’s Street Medicine Program is supported by the Pennsylvania Department of Health and a $200,000 two-year grant from the Dorothy Rider Pool Health Care Trust.
“We are like a homeless-centered medical home,” Feldman says. “All we are doing is providing a different outlet for care in a place that is acceptable to them. That’s why their ED visits and readmissions fall.”
Watch a LVHN video on the Street Medicine program.
Read more AHA News stories on how hospitals are addressing homelessness in their communities.
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