South Florida Hospital News
Tuesday February 25, 2020

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April 2019 - Volume 15 - Issue 10




Health for the Homeless

When academic, tertiary, community or even rural hospitals think about enhancing patient care delivery above and beyond quality of care, they often think in terms of the extras. Extras like patient concierge programs, comfortable furniture, on-demand scheduling, signage, aquariums and soothing décor.

However, at Camillus Health Concern (CHC), Inc. a non-profit organization that caters to the health and welfare of 5,000 homeless and underserved in the South Florida area annually, they are targeting more basic needs. Needs such as providing a woman who lives on the street a safe place to 

shower with soap and a set of clean clothes. This is because before someone can address health needs, they must take care of their most basic needs. This is necessary before they can even begin to think of how to alleviate pain from a decaying tooth, soothe the nagging bronchial cough, provide obstetrical care or treat chronic symptoms of diabetes or hypertension.
Francis Afram-Gyening, CEO since Spring, 2017 is keenly aware of the impact of social determinants of health. He earned his MPH from Columbia University in New York City and served in a variety of administrative positions with FQHCs in Cleveland, Memorial Healthcare System Primary Care Centers, Hollywood and Economic Opportunity Family Health Center, Miami. He also served as the chair of the Board of Camillus Health Concern and as the president of South Florida Healthcare Executive Forum more than a decade before he returned to Florida in 2017.
Homelessness Impacts Health
Studies indicate those without shelter are at high risk for a broad range of acute and chronic illnesses. Some health problems precede and contribute to homelessness while others are consequences of it. Obviously, homelessness complicates the treatment of many illnesses due to lack of sanitation, climate control, transportation, outreach or access to care.
Camillus Health operates an extensive outreach program to initially intervene in the health care of the homeless providing OTC medications, water, clothing and blankets in order to win their trust and build a relationship. When caring for the transient population the first option is to provide preliminary aspects of care, but case managers are challenged to build relationships helping patients to get state ID’s, find housing and create some semblance of stability which plays a key role in giving more efficient follow-up on preventive screenings, family counseling and general health.
Camillus operates three vans that transport outreach teams to locations where transients who are not in shelters congregate. Bus vouchers are also available to transport patients to sites for wrap-around care including housing, specialist services and substance use disorder. “By building a rapport with our transient patients we can help them get on a preventive health path, collaborating with sister organization such Camillus House and other social service agencies to provide food, shelter and transportation following initial care,” Afram-Gyening explained.
Additionally, while Camillus has a dedicated staff passionate about the mission, Afram-Gyening works to promote partnerships with academic institutions in the Miami region as an on-the-job recruitment tool.
“The lifestyle of our vulnerable patient population can offer students and residents an intensive disease pathology not always common within the confines of a major medical center or classroom. We offer students and residents in psychiatry, medicine, dermatology and behavioral health first-hand exposure to illness that they have only seen in textbooks. We want to enhance the students and residents experience, hopefully instilling the passion necessary to work long-term with this population,” he explained.
According to the American Hospital Association (AHA), 20% of a person's well-being is related to access to care and quality of services while 80% of health outcomes are tied to an individual's physical environment, social determinants, and behavioral factors.
For example, homeless patients may be predisposed to worse health outcomes due to unsanitary living conditions, lack of food and limited resources for self-care. The high correlation of homelessness and mental health issues supports the need for Camillus Health staff to integrate efforts of social agencies, medical teams, health care facilities, government and philanthropic organizations to partner on projects which address the on-going health needs of this vulnerable population.
Focus on Future
Camillus has been fortunate to be a recipient of several federal and local grants which most recently funded an integration of behavioral health, physical and dental care. This integration is vital for overall coordination of care, allowing patients and their caregivers to prioritize and support positive outcomes.
Camillus Health provides a comprehensive range of primary, preventive, behavioral and supplemental health care at the main site in downtown Miami and a satellite site at the Camillus House campus. 
In 2018, the development of a strategic plan outlined three distinctive goals for the next 5 years, according to Afram-Gyening:
• Increase depth of services
• Intensify relationships with academic institutions
• Explore opportunities in tele-health
Currently when a homeless person needs an x-ray, clinicians refer to a major hospital and get them in the queue which can create problems locating transients when the service is available, not to mention the problem of having to wait. However, a mobile x-ray service would empower staff to diagnose, make immediate assessments and prescribe an inclusive care plan with ortho, medical or podiatric experts to elevate standards of care.
Practicum Contact Opportunities
Camillus’ homeless and transient clients risk developing diseases of the extremities and other unusual skin disorders; increased potential for trauma, physical assault or abuse; in turn, developing detrimental coping mechanisms contributing to mental health problems and substance abuse. In a short period of time a relatively minor health problem can become a serious illness without treatment. Augmented collaboration with academic institutions would provide students encounters treating unique pathologies which will enhance their student experience while simultaneously improving the patients’ health and perhaps avoid life-threatening complications due to lack of treatment.
Tele-Health Connections
Finally, technology can help pair volunteer medical acumen with on-site clinicians and their patients to enhance health care provided. In the South Florida area, Camillus Health has identified retired PCP and specialist professionals who are eager to give back to the community with medical advice and care plans but are not able to make the physical, geographical outreach necessary to connect to the homeless. A tele-health solution could incorporate technology into diagnostics and treatment to improve outcomes, promote a preventive approach to avoid future complications, and bolster clinical capacity.
Afram-Gyening summarized his commitment, “At the end of the day, there is intrinsic satisfaction to see a full waiting room of patients empty out as a result of appropriate care management. These people become our neighbors and while hard to articulate until you’ve experienced it, you will come back to do it again the next day. You will come back not just because it is your job. You will come back because of how it makes you feel to take care of your neighbors when they need help.”

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