Health Matters: Case Managers Offer Support to Homeless to Improve Health

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Imagine, if you will, how hard it would be to maintain healthy habits if a typical day included waking up on the ground in your sleeping bag. You’re tired because you didn’t sleep well, but you rarely sleep well. You spend most of your nights anxious in fear of who will come across you while you are vulnerable. You are grateful for the security of your dog who allowed you the few minutes of sleep you did get.  Although you need to use the restroom, there isn’t one available. You’re hungry, but you have no food, and more important to you, your dog is hungry, too. You feel horrible and don’t smell good because you haven’t showered recently. Everything you own is in the backpack you’re using as a pillow to keep it safe. You're in pain and need medical care, but the clinic is miles away, and you're on foot. You don't know what time it is, but it’s early because it’s still so cold. The lure of signing up for a hot shower at the Day Center gets you up. You roll up your sleeping bag and tuck it under your backpack which you hoist onto your back. You glance back to make sure your secret spot is well-hidden and start walking.

The challenges that come with homelessness can feel overwhelming. Someone who wants to improve their situation by finding work may have a hard time interviewing when they don’t have an address, haven’t showered, don’t have a safe place to store their belongings or keep their dog. Add complicated health problems and the effects of sleep deprivation, and it can feel almost impossible to imagine a path out of this cycle.

The definition of homeless varies from couch surfing to literally living on the street. Regardless, people without safe, stable homes have a harder time than most maintaining their health. At MCHC Health Centers, we understand this and provide services accordingly. MCHC is a designated Health Care for the Homeless organization, which means we receive additional funding under Section 330(h) of the Public Health Service Act specifically to serve individuals experiencing homelessness.

MCHC case managers blend their education, skill, and experience to render appropriate services based on sound principles of practice. The case management team consists of both licensed nurses and skilled human services staff that help navigate care and assist patients in becoming more self-reliant. They provide education so patients can make informed decisions, healthier choices, and connect patients with resources to get them back on their feet.

Our case managers understand that the people they are trying to help sometimes have trouble trusting authority figures and may have different priorities than those of us who live in a more structured, time-driven world. Rather than expecting people to arrive at a health center for care, our case managers go to the Building Bridges Day Center in Ukiah and talk to people to see if they need medical care or other health services.

The Day Center, which is operated by Redwood Community Services, serves roughly 90 people a day, both adults and children. Often the people there have simple requests, bandages, and medication.  At the day center, our case managers serve as a bridge connecting the homeless with the medical community to meet their health needs. To make things easier for those who need care, MCHC provides free transportation to our services.

Our case managers also work with community organizations to help find safe housing for those who need it. There are many steps in the process to apply for housing vouchers and then find approved housing. It can be incredibly challenging and convoluted for a person experiencing homelessness to follow through on each of the requirements. Our case managers help people navigate this process.

Mendocino County promotes a housing-first model, which adheres to the principle that the best way to improve health is first to provide stable housing. Housing first is a tall order in a community with such a severe shortage of homes, but we continue to try. In the meantime, we reach out to people wherever they are to link them to services and provide excellent care.

Elisabeth VanVranken RN, BSN, CCM is the care coordination department manager at MCHC Health Centers, a local, non-profit, federally qualified health center offering medical, dental, and behavioral health care to people in Lake and Mendocino Counties.   

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