South Coast Health Initiative Helps Low-Income Residents
A free Zumba exercise class at Presidio Springs, a city Housing Authority property on Laguna Street, is part of a South Coast health initiative that is reaching out to underserved residents of low-income housing. (Photo: Melinda Burns)
Free house calls for low-income residents: South Coast medical teams take the clinic to them, courtesy of Obamacare
By Melinda Burns
Earlier this month, the paramedics found Ellen, 77, lying unconscious on the sofa in her public housing apartment in Santa Barbara. The manager, alerted by the neighbors, had called 9-1-1.
Ellen (not her real name) spent a week at Cottage Hospital, where she was treated for an infected tumor in her groin. She was released and scheduled for an appointment with her doctor, but he was on vacation. When a worker from Doctors Without Walls came by to check on Ellen, she was still disoriented, using dog food to make what she thought was black bean soup.
But thanks to a South Coast health initiative that deploys medical teams into public housing, courtesy of Obamacare, Ellen’s condition quickly improved. On a recent weekday, she was alert and using her new walker when Nicole Martinez, a nurse practitioner with the Santa Barbara Neighborhood Clinics, arrived. Her infection was healing, her blood pressure was good; the swelling in her legs had gone down.
Ellen told a reporter she had spent 34 years of her life homeless and on the streets. She asked not to be photographed because, she said, “I’ve been shot at eight times.”
“What is an oncologist?” Ellen asked, adding that she did not want to be “zapped by cobalt radiation.”
“I don’t have cancer,” she said. “I had that infection a blessed year.”
Residents of Sycamore Gardens, a public housing complex on Sycamore Lane, attend a free yoga class at the Eastside Neighborhood Park. (Photo by Melinda Burns)
Did Ellen need a ride to her doctor? Did she want someone to advocate for her during the appointment? Martinez and her assistant arranged for Doctors Without Walls, a Santa Barbara nonprofit group that serves the homeless, to provide transportation and advocacy. Did Ellen need glasses? Food? The nursing visit lasted an hour, including time for a medical exam on the sofa.
“My patients have a hard time managing the day-to-day routine things, like going to the grocery store, taking the bus, making friends,” Martinez said. “When I talk to them, they bring up 800 things besides what I see. To meet their medical needs, they need more than 30 minutes with me.”
The Health Access & Care Coordination Project – a first for California – is the brainchild of CenCal Health, the Medi-Cal provider for Santa Barbara County; and the Housing Authority of the City of Santa Barbara. In all, 29 public and nonprofit agencies are participating, providing pop-up clinics, medical screening, health fairs and in-home care for South Coast residents of low-income housing. The funding – $500,000 for 2017 – comes from the federal expansion of Medicaid under the Affordable Care Act.
“We recognized that a lot of our residents were probably underserved, not having insurance or knowing how to outreach to the proper clinic,” said Rob Fredericks, executive director of the Housing Authority. “This is a model program that should be duplicated. It was born out of our holistic vision of housing, that we’re more than the sticks and bricks we provide. We’ve seen great benefits.”
Amid ongoing Republican-sponsored efforts to dismantle President Obama’s Affordable Care Act, Fredericks is worried about how Health Access will continue next year. A bill that died earlier this month in the U.S. Senate would have phased out the Medicaid expansion by 2024. As the Senate opened debate on a repeal bill on Tuesday (JULY 25), it was not clear what the outcome would be.
“It could have some real detrimental impacts on our community,” Fredericks said. “It really takes a village to bring our residents the health care they need.”
Health Access is aimed at people who are too sick, isolated, confused or just plain fed up to navigate the system on their own, organizers said. Some clients may never have had health insurance or they only recently became insured. Many don’t have a car; others can’t drive. Some are using the emergency room inappropriately for primary care. Some haven’t seen a doctor for 5, 10, even 30 years.
Gary Pesek gets a checkup from Abril Lopez, a medical assistant, during a pop-up Neighborhood Clinic at Garden Court, a public housing complex for seniors on De la Vina Street. (Photo by Melinda Burns)
To reach them, Neighborhood Clinics and Doctors Without Walls regularly take pop-up clinics into 15 public and nonprofit housing complexes, from the Pescadero Lofts in Isla Vista to Dahlia Court in Carpinteria. Nurses from Doctors Assisting Seniors at Home (DASH), a Santa Barbara nonprofit group, make free house calls to people living in public and “Section 8” federally subsidized housing. DASH nurses help address acute flare-ups so that their clients can avoid the emergency room.
Case managers from New Beginnings Counseling Center, a nonprofit mental health center, and PathPoint, a nonprofit group that works with people with disabilities, help ensure that recently homeless clients are not evicted from public housing that they may have waited years to get into.
To date, 690 medically vulnerable, low-income residents, most of them single older adults, have been treated or screened or have attended free exercise classes under Health Access, said Hannah Greenberg, the project coordinator. Going well beyond consultations, health workers pick up patients’ prescriptions, take them to doctors’ appointments, refer them to counseling, make follow-up visits, enroll clients in Medi-Cal and feed their cats. They deliver wheelchairs, hospital beds – even clean socks. They found an adoptive home for Ellen’s dog.
“It’s not always the medicine,” said Maria Long, executive director of Doctors Without Walls. “It’s the compassion and the friendly face that is equally important, and knowing that somebody’s there who cares about them. Everybody’s deserving of kindness.”
Vera, an 86-year-old retired airport luggage scanner who lives at Garden Court, a senior public housing complex on De la Vina Street, put it this way as she waited to see Martinez for a bad back on a recent morning: “Thank God for something like this. It’s hard for me to see a doctor. I want to be examined. I want to be heard.”
Gary Pesek, 65, a retired hospital maintenance worker who was sitting nearby, said Martinez was his “primary doctor.” He said he had had three heart attacks since 2009. Martinez, Pesek said, had helped schedule him for an angiogram this month.
Nicole Martinez, a nurse practitioner for the Neighborhood Clinics, talks to Kia Norma Williams at the New Faulding Hotel, a single room occupancy hotel on Haley Street. (Photo by Melinda Burns)
“She’s saving my life,” he said. “I hate doctors and let my health go down. But she’s really perfect. She constantly calls me and does follow-ups on me and coordinates all my care.”
Eighteen California counties, including Ventura County, have recently launched pilot projects to improve access to health care for underserved residents, part of a five-year, $3 billion program called Whole Person Care. Health Access on the South Coast is not part of that program, but it is unique in that it targets residents of low-income housing, organizers said.
In Santa Barbara County, officials said, 137,000 low-income residents, or roughly one in three county residents, are enrolled in Medi-Cal, the free or low-cost health care that is known as Medicaid elsewhere in the United States. Of the total, 55,000 have enrolled since 2013, when the Affordable Care Act went into effect.
Some people hang up because they think they're talking to a salesman, Greenberg said. But most Health Access services are free. A handful of patients, those who are uninsured, are charged about $45 for a consultation with Martinez, the nurse practitioner. The fee includes lab work and prescriptions.
During a recent pop-up clinic at the New Faulding Hotel, a single room occupancy hotel on Haley Street, a medical assistant with the Neighborhood Clinics arranged prescription refills for Jack Wilson, 61, as he sat in the lobby. Wilson said that since he began seeing Martinez, the nurse practitioner, in April, he has been treated for high blood pressure, diabetes and a melanoma. He’s scheduled for cataract surgery this summer.
Wilson said he “gave up on everything” after bad eyesight caused him to lose a lucrative job in fiber-optics eight years ago.
“I was pessimistic,” he said. “I just wanted somebody to guide me to good health again. These guys have helped me more than anybody.”
Melinda Burns is a freelance journalist in Santa Barbara
[Editor's Note: An earlier version of this story mischaracterized the cost of Health Access services to low-income residents. Most but not all services are free. Uninsured patients are charged a nominal fee to see a nurse practitioner.]