RHC: Sisters of Providence Health System

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The Mercy Health Care for the Homeless (HCH) program began in 1983 in a Springfield, Massachusetts soup kitchen, operated by the Sisters of Providence. Arriving with basic medical supplies in the back of her station wagon, a Sister of Providence who was also a nurse practitioner began ministering to the homeless people who frequented the soup kitchen. Obvious abrasions, old wounds, untended coughs were evidence of the lack of basic health care among this population. Not limiting herself to the soup kitchen, Sister quickly extended her ministry to the streets, shelters, and even local bars.

In the 1980's, the program began to grow with financial support from the Sisters of Providence and the recruitment of additional volunteers. A local foundation awarded a small grant that enabled the program to hire two part time staff. In 1987, the Stuart B. McKinney Homeless Assistance Act was passed, reflecting the federal government's concern with the growing numbers of homeless persons residing in cities throughout the country. Mercy HCH, together with two partners, the Springfield Public Health Department and Open Pantry Community Services, Inc. applied for and in 1988 received one of the first grants awarded through the McKinney program. This support allowed Mercy HCH to hire a team of four providers, serving clients at eight sites in Springfield. In 1988, the team cared for about 800 clients, providing just under 2,000 encounters for a comprehensive array of medical needs.

Implementation

Today, the nine-member Mercy Health Care for the Homeless team provides primary care services onsite at 29 shelters, soup kitchens, job placement sites, and transitional programs. Services are delivered in four Western Massachusetts cities: Springfield, Holyoke, West Springfield, and Westfield. In 1998, Mercy HCH cared for over 1800 individuals in its service area. These men, women and children had approximately 8,000 encounters with HCH staff. The HCH team follows a nursing model of health care, providing assessment, intervention, referrals, follow-up and education. The team consists of five RNs, two Nurse Practitioners, a part time Medical Director, a Nurse Manager, and an Executive Director. Their service capacity is greatly extended by a corps of approximately forty volunteer physicians. These physicians accept referrals directly from HCH nurses and provide medical services in their offices free of charge.

Mercy Hospital in Springfield, a member of the Sisters of Providence Health System, is the cornerstone of the HCH program, providing laboratory, x-ray, and inpatient services to clients. HCH nurse practitioners are credentialled and have on-staff privileges at Mercy. The Mercy Emergency Department provides back up during hours when HCH staff is not available; staff is notified of any homeless clients' admission to either the emergency room or the hospital.

To ensure that Mercy's services extend to even the hardest to reach, a new Street Outreach team was added in 1998. Supported by a Housing and Urban Development (HUD) grant, the HCH Street Team is a joint effort of three organizations, Mental Health Association of Greater Springfield, Alcohol and Drug Services of Western Massachusetts, and HCH/Mercy. Working on the streets, at the bus terminal, in cemeteries, and under bridges, the team searches for the "hang out" spots of the hardest to reach of the homeless population. The goal is to reach those with mental illnesses who avoid any contact with the mainstream health and social service system. In the first month, the Street Outreach team made contact with 29 clients who were completely new to the "system." Clients include a double amputee living with a group of homeless people in a cemetery, and a middle-aged man with Huntington's chorea, who, after establishing a trust relationship with the HCH team, accepted placement in a nursing home. In subsequent months, the team has continued to identify and serve significant numbers of underserved and unserved clients. The majority suffer from mental illness.

The most recent strategy for extending Mercy's reach is to seek funding to expand the program to two rural areas approximately one hour north of Springfield, which will result in the addition of eight new sites.

Time Frame

Since its inception in 1983, the Mercy HCH program has been an ongoing and expanding effort to identify homeless persons in Western Massachusetts, assess their needs and resources, deliver health and social services, and evaluate their impact. Services are provided throughout the year on a daily basis with back up arrangements for 24-hour, emergency coverage. While Mercy HCH is active in advocating for policy changes that will address the root causes of homelessness, the problems of poverty, inadequate housing, and family dysfunction are likely to persist, resulting in an ongoing need for Mercy HCH. If funding is awarded, Mercy HCH will expand its services to rural northwestern Massachusetts in FY 2000.

Financial Profile

Mercy HCH's budget is $763,147. Approximately one third of the budget revenues are derived from McKinney and HUD homeless funding. Twenty five percent is provided through state and federal contracts. The Sisters of Providence Health System provides over 40% of the support for Mercy HCH (approximately $315,000).

Outcome

The key outcome indicators for the Mercy HCH project are directly related to the project's goal of ensuring homeless persons' access to a comprehensive system of health care and related services. While achieving a stable situation in the community with appropriate housing, health care, employment, and other resources is the ultimate outcome, Mercy HCH recognizes the importance of acknowledging many intermediate benchmarks of progress toward that long term goal. These include: