BOSTON HEALTHCARE FOR THE HOMELESS PROGRAM (BHCHP)

At the November CRC Information Session, Doctors Elizabeth Cuevas and Pat Perri presented the Boston Healthcare for the Homeless Program, with an overview of its services and work within MGH.

Overview

The Boston Healthcare for the Homeless Program (BHCHP) was founded in 1985 to provide access to healthcare for all homeless individuals and families in the Greater Boston area. In 1987 the program became a federally accredited community health center, allowing for third party billing, which has been a major factor is BHCHP’s ability to become self-sustaining.

BHCHP employs doctors, nurses, social workers, case managers and other health care professionals. Their staff provides services at more than 70 sites of care, in homeless shelters, in their own community health center and on park benches, under bridges and in alleyways– wherever homeless people are found.

The BHCHP has become a great resource for healthcare professionals throughout Boston, including those here at MGH. Referrals come in from social workers and case managers, as well as from medical teams throughout the hospital.

What Services Does BHCHP Provide?

In the hospital setting, the Boston Healthcare for the Homeless Program provides a variety of services to assist both homeless individuals at MGH, and healthcare teams. The BHCHP professionals provide bedside consults and can give recommendations on medical management for problems which are often unique to the homeless population. One example is “trench foot” – a pervasive condition of the homeless caused when one’s foot gets and stays wet. Trench foot frequently leads to skin breakdown and then cellulites and other serious conditions. The BHCHP team works towards trust building between the patient and the primary inpatient team, assesses appropriateness for the Barbara McGinnis House, and provides information on additional homeless services and resources in Boston.

Additionally, the BHCHP team is integral in helping to coordinate many homeless individual’s medical care. With the patient’s consent, they are able to access patient background information from their electronic medical records and communicate with other BHCHP providers who may be involved in the patient’s care, improving the continuity and quality of their care. The BHCHP’s long-term relationship with their patients and dedication to meeting them “where they are” may make the homeless individual more likely to seek and adhere to medical care and regimens.

What Services Does BHCHP Not Provide?

Unfortunately the Boston Healthcare for the Homeless Program cannot become primary care providers for all homeless patients. However, the program can help to co-manage a homeless individual’s care once the patient has been assigned to a primary care physician.

Likewise, the BHCHP cannot “fix” all homeless patients or promise to locate patients for follow-up appointments. The program cannot be expected to create ideal discharge situations in every case or prevent homeless patients from leaving against medical advice. This includes not always being able to create an immediate opening at the Barbara McGinnis House. It is not uncommon to have to wait up to a week for a bed.

What is the Barbara McGinnis House?

The Barbara McGinnis House (BMH), located in Jamaica Plain, is a medical respite program that serves homeless and marginally housed men and women from the Boston area. The facility has between ninety and one hundred beds, and is utilized as short-term housing for individuals who do not require hospitalization but are too ill to return to the streets. Referrals for BMH beds come from hospitals, clinics, shelters, as well as street encounters by the BHCHP team.

To be eligible for McGinnis house, applicants must be ambulatory and independent in performing activities of daily living (ADL’s). Once housed at BMH, men and women are cared for by professional staff, including doctors, nurses, social workers, and case managers, who have experience in dealing with the unique medical and psychosocial challenges that face homeless people.

The BMH provides nursing care with some limitations, an on-site pharmacy, mental health services, van transportation to programs, appointments, and other necessary outings and public benefits advocacy. The Barbara McGinnis house in also able to accept pregnant women or post-partum women without an infant.

What is it Not?

The Barbara McGinnis House cannot and does not act as a homeless shelter, group home, alcohol or drug abuse treatment program, nursing or rehab facility, or a solution for long-term housing. The BMH cannot be used as a primary detox facility, though they can take patients who are detoxing if there is another primary medical diagnosis. They cannot do Methadone detox. The BMH is not an unlocked facility, where residents can come and go as they please. Individuals staying at the McGinnis House may leave the facility via the BMH van only. Lastly, the BMH does not provide private rooms and cannot always provide an immediate bed.

“Housing First” Initiative

The Boston Healthcare for the Homeless Program has recently begun to focus on the ‘Housing First’ model that is being piloted across the country and that turns conventional understanding and practice on its head. This plan would quickly provide housing for homeless individuals first, and then incorporate other services into the person’s life to help stabilize them and keep them housed. A challenge that may arise out of this arrangement is that often homeless people need to be totally re-acculturated back into housing, as some have not had to care for a home in many years. BHCHP hopes to work with these individuals to teach them to manage everyday household activities and reintegrate them back into the ‘housed’ lifestyle. Housing First programs were among the victims of Gov. Romney’s recent budget ax. It remains to be seen whether the funds for this important pilot will be reinstated.

Homeless Inpatient Care Tips

When working with a homeless individual in the inpatient setting, there are a few tips that may make providing care easier for professionals or more pleasant for the patients.

• Patients may have multiple record numbers under different spellings of his/her name or different birth dates.
• If important tests need to be done, do them while the patient is in-house, don’t assume follow-up appointments will be met.
• Discharge homeless patients with their pills in hand and follow-up appointments clearly written with dates, times, and locations. Don’t expect them to set up appointments themselves. Medical follow-up tends to take a back-seat to daily survival on the streets.
• Key shelters require guests to sign-up for a bed in the morning. If discharging a patient to a shelter, do so early in the day or call ahead to the shelter so the individual has a chance at getting a bed for that night.
• Assess individuals for public benefit programs, because otherwise they may fall through the cracks.
• When you have questions or need help, call, email, or page a member of the BHCHP team (see contact information below).

How to Best Help Homeless Individuals and Improve Healthcare Access

When providing care to homeless individuals, avoid stereotypes of homeless people and beware of the “three hots and a cot” myth. Homeless individuals often place healthcare low on their priorities and do notwant to be hospitalized. Most importantly, remember homelessness is a life of shame, suffering and humiliation. Interventions have the possibility of having a huge effect on a homeless individual’s life if they believe you truly care. Give more respect and kindness to homeless patients and you’ll likely get more in return.

General Homelessness Information

• The average age of a homeless person in Boston is mid-thirties.
• The average age of death for a homeless individual is 47 years old.
• The single largest risk factor for death in the homeless population is medical conditions, not mental illness or substance abuse, as many assume.
• Inpatient hospitalization is one of the most valuable opportunities for intervention with the homeless population.

General Boston Shelter Information

• BHCHP now manages the medical care at the New England Shelter for Homeless Veterans, which was formerly by the Veteran’s Association. The New England Shelter is a dry facility.
• Pine Street Inn and the Long Island Shelter are wet shelters for ambulatory homeless individuals with no significant behavioral issues. Though generally people need to be out of the shelters during the day, these facilities can allow individuals to stay in for medical reasons or in severe weather.

Contact Information for the BHCHP:

Boston Healthcare for the Homeless Program, 749 Massachusetts Ave. , Boston, MA 02118, (617) 414-7779,www.bhchp.org, Email: homelessclinic@partners.org, BHCHP Pager: (781) 221-6565.

- Special thanks to Doctors Elizabeth Cuevas and Pat Perri for their presentation

11/06