The impact of homelessness on health and well-being cannot be overstated. Exposure to the elements, communicable diseases, violence, malnutrition, and lack of care are all significant factors that impede a person’s ability to remain healthy.
Hepatitis C, lung disease, diabetes, hypertension, and high cholesterol are just a few of the conditions commonly found among homeless people, and these are frequently mixed in with psychiatric and substance abuse issues.
These serious health conditions can be readily treated with consistent primary medical care and widely available medications. But the harsh reality is that homeless individuals often remain outside of the medical system. Even after their homelessness has been resolved, they can carry the aftermath of that exclusion, both psychologically and physically, throughout their lives.
CUCS’ Janian Medical Care provides psychiatry and primary medical care to thousands of homeless and formerly homeless individuals throughout New York City.
CUCS has created a practical yet novel model of care that integrates psychiatry, primary medical care, and case management to help people live healthier lives.
Primary medical care at CUCS is a holistic endeavor among medical and psychiatric practitioners, social workers, and case managers that brings health care services to people where they live, whether in housing programs or on the streets.
Dr. Margo Simon came to CUCS three years ago to help launch Janian’s primary medical care program for formerly homeless and homeless individuals with complex medical conditions.
A psychiatrist and family medical practitioner, Dr. Simon has spent her entire career working in settings that have been at the intersection of health and the under-served. It is challenging, difficult work.
This morning, Dr. Simon will begin her day at CUCS’ medical suite at the Prince George, a supportive housing residence in Manhattan, meeting with the program’s licensed practical nurse (LPN) and the site’s medical liaison, who is a CUCS social worker.
The team reviews the clinical schedule and updates Dr. Simon about patient charts, lab work, and referrals from past appointments.
Trying to get a complete picture of a patient’s health can be a struggle, as there are no available outside medical records in some cases, and those that do exist can be difficult to acquire or are incomplete and outdated.
First on the schedule for the day is Pat, who struggles with a series of chronic health conditions that are exacerbated by his alcohol and substance addictions. The team was only able to obtain incomplete medical records from the prior year for him.
A lifetime of drinking, smoking, substance abuse, and homelessness has taken a toll on Pat. He is sixty years old and underweight by 35 pounds.
Today, Dr. Simon is addressing Pat’s recent hospitalization. After getting into a fight, he was kicked repeatedly in the face, neck, and ribs. Pat suffered severe facial injuries, but cannot get an appointment for a specialist to treat him for another month. The team will press to get him an earlier appointment as his facial fractures will set soon.
During this ER visit, an aneurysm in Pat’s carotid artery was found. While it does not appear to be life-threatening, Dr. Simon pays careful attention to helping Pat understand this condition.
The typical 7-10 minute visit schedule in the mainstream health care system leaves little time to help patients understand their medical conditions. The freedom of time Dr. Simon has to explain conditions and treat patients like Pat is a pillar of CUCS’ care model.
For months now, Dr. Simon and her team have been working intensively with Pat on getting him into care for his severe alcohol use disorder. It is a slow process that is complicated by his periodic heroin use.
Pat has been in this vicious cycle for decades. He continues to assert that he wants to stop drinking, but does not need to go to rehab. The team knows, however, that Pat’s perception of what it takes to achieve sobriety is much different than theirs.
His care team continues the engagement process, working to help Pat see the devastating impact of the addiction on his health and well-being.
Entering treatment is a commitment to change that seems insurmountable for Pat. Yet by the end of the appointment, he has made a promise to enter detox.
Graham, the second patient on Dr. Simon’s schedule, has recently moved off the streets. He is joined by Lina, his CUCS case worker, for the appointment.
An elderly gentleman, Graham has an array of complicated medical conditions that Dr. Simon is addressing. Today she starts with a recent referral to see a podiatrist.
Skin and foot problems are common issues faced by homeless people, especially those that have lived on the street. Frostbite, trench foot, ill fitting footwear, bad hygiene, and side effects of diabetes can leave many with severe foot conditions.
Lina went with Graham to his podiatrist appointment, as she does with most. It is difficult for people who have been excluded from the traditional health care system for a majority of their lives to navigate it, even when they are safely housed.
It was a good thing Lina went to the appointment. Soon after it started, the podiatrist asked Lina to join him in the exam room. Upon seeing Graham’s feet he was concerned about elder abuse.
Lina was able to help Graham explain his history of homelessness and health issues to the podiatrist who, in turn, was then able to provide better care for him. Though still raw today, Graham’s feet and legs are on the mend.
In addition to the issues with his feet, Graham has cataracts. Yet he hasn’t had eye medication since 2008.
This means another referral for Graham and Lina, who will be by his side to help navigate the complicated community health care system.
Dr. Simon will also be by his side, continuing to work with Graham to address the myriad of serious health issues he faces. But she also sees a level of independence in Graham that may make him a candidate for transitioning out of the program and into care in the community.
Our mission at the Center for Urban Community Services | CUCS is to rebuild the lives of homeless and disadvantaged individuals and families. Each year more 50,000 people receive help from CUCS.
CUCS excels at providing integrated programs that link housing, health, and social services for New York City’s most vulnerable adults and children. Our programs help people exit from homelessness, rise above poverty, regain health and wellness, and rebuild their lives.
CUCS’ primary medical care initiative is made possible by the generous support of the Altman Foundation, The New York Community Trust, the New York City Department of Homeless Services, the Oak Foundation, Robin Hood Foundation, and the Stavros Niarchos Foundation.