“I’ve been locked up in mental institutions and prison. If it hadn’t been for the team here, I wouldn’t be talking to you right now. When I’m feeling depressed, I pick up the phone and I call my psychiatrist and talk.”
These are the heartfelt sentiments of Larry Adams, patient and chairman of the consumer advisory board of the Boston Healthcare for Homeless Program (BHCHP). First of its kind in the nation, BHCHP serves 12,000 patients through over 60,000 visits a year in more than 80 locations. For more than 25 years their mission has been to provide or assure access to the highest quality health care for all homeless men, women, transgender and children in the greater Boston area.
As part of one of the field trips offered at Health Journalism 2013, journalists toured the bright and warm facility where health care teams mobilize to serve the most underserved of Boston’s residents.
Boston’s most vulnerable patients receive what the staff considers to be dignified care. Tour attendees heard stories from medical and therapeutic staff about how they feel each of their contributions – from medical care to a listening ear to continued patience – have helped improve the quality of life of their homeless patients who stay an average of 13 days. Because offering the services to live with dignity is so important to the staff, they have extended that in the development of their palliative care so that patients are offered options for dignity in their last days.
Primary care, behavioral health and oral health have been the hallmarks of the center’s efforts. With continued partnerships throughout the city, the BHCHP staff has tried to reduce the influx of homeless patients flooding emergency rooms by addressing chronic illnesses such as diabetes, cirrhosis and cellulitis. BHCHP manages and staffs shelter clinics across the city, consolidating services and saving money.
The center, which has a 2014 projected budget of $40 million, gets 75 percent of its funding from Mass-Care and 25 percent from private funding and grants. The relationship with the state offers a special line item for the billing of services. Because the center is not a hospital or a clinic, the special line item is billed as respite care.
Ultimately, the challenge of addressing the issue of homelessness still looms. When patients leave the center, staff members are many times conflicted about the discharge plan that includes the hopeful option of family or a treatment center, but the reality is often a shelter or the unknown of the streets.
“The hardest part of the job is the discharge because you know they may be going back to shelter,” said Melinda Thomas, PAC, associate medical director of Barbara McInnis House.
The BHCHP plans to continue to manage chronic illnesses, ensure that women have pap smears and mammograms, develop programs to address addiction and tobacco cessation and the overall continuation of quality care via an integrated care model.