“When you’re out and you’re in it, and you’re meeting these people and connecting with them, you just want to do everything you can,” said Sara Pisa, project manager at Neighborhood Health Center and a member of Neighborhood’s Healthcare for the Homeless (HCH) street outreach team.

Neighborhood’s HCH outreach team is at Harbor House Homeless Resource Center (241 Genesee St) in Buffalo from 9-10pm once a month through the summer, to connect people with primary healthcare services. Harbor House is a late-night resource center, open from 9pm-6:30am, that aims to connect people in need of housing, legal, and other supports. It also offers a chance to get laundry done, charge a phone, or eat a late-night meal. 

Following their regular HCH street outreach from 7-9pm, Sara and a few of Neighborhood’s community health workers (CHWs) go to Harbor House from 9-10pm. When they arrive the team at Harbor House provides them with a list of people there that are in need of healthcare services. The HCH team then sets individuals up with next-day appointments to see a primary care provider at Neighborhood. 

On average, Sara and the CHWs have been able to schedule two to three people for new patient appointments each evening they spend at Harbor House. If needed, they have also been able to link people up with other Neighborhood services, like behavioral health counseling, dental care, and podiatry. For those who are established patients with Neighborhood, Sara helps them with scheduling follow-up appointments at the health center. 

“For everyone we end up scheduling, about 25% actually show up to their appointments,” said Sara. While that number might not seem terribly successful, that 25% are individuals who were not previously being seen for primary healthcare at all. According to NACHC, health centers like Neighborhood reduce the need for emergency room visits. Keeping people out of emergency rooms ultimately saves patients and the healthcare system money. The unhoused population tends to have more challenges and barriers in getting to healthcare, including lack of transportation. To help with this challenge, the HCH team offers bus passes to those they are scheduling appointments for. 

“It has been a really positive experience, we built a lot of trust with the people that come to Harbor House for support,” said Sara. “We became these familiar faces and that is meaningful.”

A Step in the Right Direction

Sara shares the story of a gentleman that the HCH team had seen during outreach for at least a year, but had no success in talking with him about healthcare. They then saw him at Harbor House where he is a regular. He opened up and shared that he has COPD and lung cancer. He had been going without the primary and oncology care he needed for at least a year, and would go to the emergency room when he absolutely needed care or medication. 

“I think it really said something about the safety that people feel at Harbor House. We saw this person more than once for over a year, and never once did he feel comfortable or safe enough to say ‘this is what I need’,” said Sara.

He shared that he was attempting to see an oncologist who was out in Williamsville. Without a phone, he had no way of calling to make that appointment. Without a means of transportation, he had no way of getting there. Sara was able to get him in for an appointment with a primary care provider at Neighborhood. They have since been trying to get him scheduled with an oncology specialist, which has proven to be a bit difficult between transportation barriers and insurance complications; both of which Neighborhood’s CHWs have been able to support him with. 

“Though it is still a struggle to get him to the specialist he needs to get to, I think at least showing up for his primary care appointments, getting these referrals, getting his medications; it is a step in the right direction,” said Sara.

Changing Lives

An unhoused person often needs a certain documented medical diagnosis to be considered for housing, or to be boosted up on the housing list.

This ended up being a crucial factor for another man that the HCH team connected with through Harbor House. They got him in for a primary care appointment. Two weeks later, Sara saw him again. 

“He came up to us and said ‘you guys saved my life’,” said Sara. “And that is super heartwarming to hear.”

Sara has since learned he is now housed in a bridger complex with one of the housing providers in Buffalo. This means he now has a consistent place to stay, with the promise of a more permanent housing situation soon – all because he was able to be connected with primary care. 

The Impact of Health Literacy 

Sara shares another story of an individual they scheduled for a primary care appointment with Neighborhood. However, he unfortunately showed up hours late to the appointment (possibly because of transportation barriers). He was rescheduled for the next day, and he did not make it to that appointment either. 

“When they don’t show up, part of me needs to remind myself that this is not a reflection of me, the team, or the program,” explained Sara. “In a population that often needs so much more support in getting to the health center, we have to have compassion for what they are going through.”

Once back at Harbor House the team followed up with him. Sara told him that they had to schedule a few other people ahead of him, but that she would loop back around and get him set up for another appointment. A few weeks later, they were finally able to schedule him for another appointment, and he did not make it to that appointment either.

“It can be challenging emotionally at times, but at the end of the day, we go back and we try again,” said Sara.

The next time Sara saw him was at the bus station during their regular HCH outreach. He went up to Sara and pulled out a printed appointment form. 

“He himself went back and scheduled his own appointment,” said Sara. “He is a patient that doesn’t have a phone or access to transportation, so he must have just walked over there to make his appointment. He is taking the initiative to make his own appointment, and he was really proud of it. I was so proud of him for doing that.”

This also indicates how he is seeing the importance of primary care, he is learning how to advocate for himself in the healthcare world by making his own appointment, and he is taking accountability for the appointments he knows he needs.  

“We aren’t clinical people, we can’t provide that care onsite or diagnose anyone,” explained Sara. “The best we can do is share our knowledge and connect people with the care they need.”

Going the Distance

A bonus success story in Neighborhood’s partnership with Harbor House involves a regular of Harbor House who was diagnosed with a scabies rash. Since scabies is highly contagious, he couldn’t be at Harbor House until he got treatment for it. He could not afford the medication to treat it, so Harbor House contacted Neighborhood Health Center. 

Sara was able to work with the pharmacists at Neighborhood Health Center Blasdell to get the cost of his medication down using coupon codes. 

Sara picked up the medication for him and says he was able to treat himself and come back to Harbor House for shelter. 

“They know our faces, they know who we are, and a lot of them really want the appointments. This is a good start to getting people in our community under stable and accessible medical care, that is not the emergency room,” said Sara. 

Neighborhood Health Center has been an established ‘Healthcare for the Homeless’ provider since 2012. To learn more, click here.