Homelessness can impact both physical and mental health, and make accessing medical care difficult. As a result, people experiencing homelessness often face higher rates of poor health outcomes than people with housing.
Which leads us to the next question in our Toughest Questions in Health Care series: How can health care impact homelessness? Dr. Ben Golden, Program Director for the ChristianaCare Medical Respite Program at the New Castle County Hope Center, and Dr. Ashley Panichelli, Clinical Director for ChristianaCare Complex Primary Care share details on the difficulties that arise in providing care for patients experiencing homelessness, steps that ChristianaCare is taking to counter those issues, and their hopes for the future in this field of care.
Dr. Ben Golden, M.D., completed his medical training at Rush University Medical Center in Chicago, IL where he took an interest in healthcare disparities and care for patients experiencing homelessness. As Program Director for the ChristianaCare Medical Respite Program at the New Castle County Hope Center, he provides complex primary care for the residents of the facility. Dr. Golden also continues to practice Emergency Medicine at all of Christiana's sites.
Dr. Ashley Panichelli, M.D., the clinical director of Complex Primary Care and Community Medicine at ChristianaCare. Dr Panichelli is passionate about teaching, mentoring, and program development, and routinely speaks to the news media about family medicine and the importance of vaccinations. Dr Panichelli’s specific interests include inpatient medicine and safe transitions of care, residency quality and safety, Just Culture, women's health, and resident simulation curriculums.
Links
- ChristianaCare News - ChristianaCare Rolls Out New Mobile Health Services Vans Supported by Barclays
- ChristianaCare News - ChristianaCare Talks Community Health With Wilmington, State Officials
- ChristianaCare Mobile Health Services
- New Castle County Hope Center
- Friendship House
- Food Bank of Delaware
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
These are people, these patients are already here.
This is our issue.
This is a health care issue.
We can't shirk our duty here.
Speaker 2 (00:09):
You're listening to For the Love of Health, a
podcast about delivering careand creating health, brought to
you by Christiana Care.
And now here are your hosts.
Speaker 3 (00:19):
Hello everyone, I'm Megan.
Speaker 2 (00:20):
McGerman and I'm Jason Tokarski.
Welcome to For the Love ofHealth brought to you by
Christiana Care.
Speaker 3 (00:25):
Homelessness can impact both physical and mental
health and make accessingmedical care difficult.
As a result, peopleexperiencing homelessness often
face higher rates of poor healthoutcomes than people with
housing.
Speaker 2 (00:38):
Which leads us to the next question in our Toughest
Questions in Healthcare serieshow can healthcare impact
homelessness?
Joining us today to tackle thatquestion are Dr Ben Golden,
program Director for theChristiana Care Medical Respite
Program at the New Castle CountyHope Center, and Dr Ashley
Panicelli, clinical Director forChristiana Care Complex Primary
Care.
Speaker 3 (00:58):
Ben and Ashley, thank you both so much for being here
today.
Speaker 1 (01:01):
Thank you for having us.
Speaker 3 (01:02):
Yeah, thank you, glad to be here.
What do the local and nationalconversations on homelessness
sound like right now?
Speaker 1 (01:09):
Well, not great at present.
The tone out in the communityright now is one of concern.
In 2023, nationally, there'sbeen an 11% increase in
homelessness and in Delawarealone, it's 9% increase from
2023.
From 2020 until now, there'sbeen a 58% increase in the
individuals rough sleeping outon the street, and I can tell
(01:31):
you that there's been a lot ofconcerns regarding the grants
pass decision, which has removedsome protections from the
Eighth Amendment for thiscommunity.
Historically, manymunicipalities have been
required to provide options forpeople rough sleeping out on the
street, so not sleeping in ashelter, but sleeping in a park
or in a car or out on the streetitself.
(01:53):
If there were shelter bedsavailable, if there were
resources available and patientschose not to take advantage of
them, then they could beticketed, fined or arrested not
to take advantage of them, thenthey could be ticketed, fined or
arrested.
The Grants Pass decision saidthat you no longer have to have
those restrictions, and fining,ticketing or arresting people
(02:17):
sleeping outside does notconstitute as cruel and unusual
punishment.
We've already seen sweepshappen in Philly, in Los Angeles
and in San Francisco, and eventoday I've had patients express
concern about what's going tohappen here when it finally
arrives.
So there's a lot of people arevery nervous about what little
resources they have already.
Speaker 2 (02:32):
How does health care and homelessness?
How do they connect, how dothey affect each?
Speaker 1 (02:38):
other.
So there are many responses tothis question.
I think, pragmatically, thesepatients have medical illnesses.
Patients who are experiencinghomelessness have been shown to
have 3.5 times the mortalityrate associated with their
homelessness than their housedcounterparts.
A 40-year-old homeless patienthas a similar mortality risk to
(03:02):
someone who's nearly 20 yearsolder.
So independently based on thehousing status.
So these people have medicalillnesses, they have risk
factors and, pragmatically,they're already in the offices,
they're in the emergencydepartments, they're in the
hospital.
Like this becomes an issue thatwe have a patient in front of
us, we should take care of themand, like any other risk factor
(03:25):
for healthcare, for medicine,these things are modifiable.
Just like when we talk aboutsmoking with heart disease,
affecting a person's housing canreduce their comorbidities.
So providing housing forpatients, working on housing for
these patients, is a medicalintervention that can be done
(03:46):
for them to have long-termbenefit, but it has to be a
long-term solution.
Speaker 2 (03:50):
And I would assume there's also got to be an angle
of the care that can be providedto someone who is homeless is
different because of what youcan offer them for those
treatments.
Speaker 1 (04:02):
Absolutely, as we've found in our time working with
the mobile clinic.
The strategy for healthcaredelivery has to be unique,
because these patients' journeyand medical conditions are
unique.
These patients don't haveplaces to store medications,
they don't have ready access tothings like bathrooms, so if you
have a person on a diuretic ora person on insulin, they have
(04:24):
no place to regularly use therestroom or refrigerate their
insulin.
So you have to be more creativeabout these things.
In addition to this, many ofthese patients have severe
comorbidities.
One in five have a communicabledisease.
Two of three meet criteria forsevere mental illness, when it
exists.
Most patients have been exposedto violence and hunger.
30% reported substance usedisorder, and so you have to be
(04:48):
able to tailor a lot of thetextbook healthcare delivery to
their unique environment.
We'll have five patients with asimilar complaint, but we'll
have five different strategies.
Speaker 3 (04:59):
Let's talk more about what ChristianaCare is doing to
directly find this and helpthis population.
You've mentioned the mobile van, the mobile health services van
, of which, ben, I know you arethe lead physician on the van
that's based in Wilmington.
Talk about how that works, howpeople can find you and really
the purpose of this van.
Speaker 1 (05:20):
Our vision has really morphed over the year that
we've been out doing this andwe've had great expansion.
We now have seven sites aroundthe greater Wilmington area.
Patients can find us a varietyof ways.
We are setting up hotlines forpeople to call in to find out
where we are that day at thattime and we're working to
increase services so that we'reout every single day, not just
(05:42):
twice a week right now.
Speaker 4 (05:43):
And we really partner .
You know, and are continuing tolearn and evolve in this
process and learn you know whoour community partnerships are
and to help best serve communitymembers.
You know, I think one of thegreat things about this is maybe
we went in and our partnerswent in with ideas of where
would the best places to be andhow to best serve patients, and
(06:03):
then you know we're learning andmaybe a community member from a
community organization isreaching out and saying, hey, I
have, you know, a lot of maybeparishioners or people coming to
my community center who needhelp or from different you know
types of organizations and areasking for us to partner, and
it's been really great.
We can kind of pivot and figureout who to best partner with to
(06:26):
help you know the patients thatare most in need and, quite
frankly, maybe the most unlikelyto come to some of our brick
and mortar practices, which is,I think, the most rewarding part
and our favorite part.
Speaker 3 (06:38):
Your team also does a lot of work in the Newcastle
County Hope Center.
Talk to us about that.
Speaker 1 (06:44):
The Newcastle County Hope Center is a large
transitional living facilityhoused in the old Sheraton on
Airport Road just outside ofWilmington.
Christiana has partnered withthem since they opened to
provide healthcare services onsite.
A few years ago we establisheda 36-bed medical respite program
.
We're the first and onlymedical respite program in the
(07:06):
state of Delaware.
We provide services to patientsthat have complex health care
needs but don't require fullhospital level of services.
So we accept many patients fromthe hospital that require a
little bit more care, and beingout on the street or being in a
shelter would be detrimental tothe healing that's already
occurred.
We have a very dynamic modeland a multidisciplinary model to
(07:28):
try and connect with multipledomains within the social
determinants of health, medicineand healthcare being sometimes
a smaller portion of some oftheir overall needs.
Speaker 2 (07:37):
Obviously, the goal is for any patients that you're
seeing not to be stuck in thissituation forever.
So do you have any proceduresthat you go through to try to
help someone transition from theHope Center, maybe to then
being out elsewhere, so thatthey can receive services from
the mobile van and maybe eventhen to the brick and mortars,
as you say?
Speaker 4 (07:57):
Yeah, that's something that in complex
primary care we're reallythoughtful about and always kind
of shifting and changing andare very dynamic in that both
our clinicians and ouroperational team about how our
you know, our spaces really fittogether best.
Because we do have multiple, youknow, patient stories of
patients who may go frominpatient setting at the
(08:19):
hospital, who then maytransition to the Hope Center
and then, once they're, you know, able to leave the Hope Center.
We understand and value thatthey still need that primary
care and are going to needongoing management and they may
be able to transition maybe tothe mobile van or to one of our
brick and mortar practices.
And I would say we're stilllearning, but we're trying to
make workflows and strategies toreally best connect patients in
(08:43):
a streamlined fashion so thatthey know that, you know,
despite this next transitionpoint, their health care is
still going to be managed andthey're still going to be able
to get what they need.
Luckily, some of our clinicianscross different spaces, which
is a really valuable thing, Ithink about our group, but even
not if not, we have greatcommunication between our teams
and between our differentlocations.
Speaker 3 (09:05):
Ben, earlier you mentioned social determinants of
health.
How do you dig through that?
I know, Ashley, a lot of thepractices that you work with now
are doing social determinantsof health screenings.
Are you also doing thosescreenings as you meet with
these patients?
Speaker 1 (09:20):
Ours has a little bit more of an organic feel to it
at the moment because many ofthese things come up in
conversation.
Sometimes people will enterinto the mobile van not because
they want to be seen by aprovider, but because we have
bottled water, because we havesnacks, we have hand warmers,
things like that, and so a lotof these discussions happen
because that is their presentingneed and we're trying to
(09:42):
capture more of the formal datato truly understand the needs of
our various communities, ourseven sites.
Speaker 4 (09:48):
And I would say that's one of the things that
we've really kind of evolvedwith our work on the mobile van
is, you know, we had one visioncoming in of this is how we
would care for these patientsand this is what we should do.
And then we learned, oh,actually, you know, we really
need to pivot.
We're excited to talk to youabout your preventative health
and your chronic disease, butthat may not be first thing on
(10:08):
the list, and so when we'rereally thinking about the mobile
van and what we have access toand the work that Dr Golden is
doing is, let's really shiftthat priority list around,
because it may look different inthis setting than it does in
maybe one of our brick andmortar practices, and that, you
know, is something that we're isconstantly evolving, based on
season, based on location thatwe're in, and so something that
(10:31):
you know we take in ouroperations team takes, you know,
takes a lot of our time andwhat we're what we're really
thinking about.
Speaker 3 (10:38):
What do you want someone to understand about the
population that you're workingwith?
Speaker 1 (10:43):
These are people.
People experience homelessnessand it's complicated and it's
messy, but at the end point,even if we can't solve a very
complex issue in the immediatemoment, we can always be kind
and we can always have a senseof empathy.
The studies show that there isa large portion of this country
(11:05):
that is at threatenedhomelessness and threatened
housing insecurity.
I've met people with doctoraldegrees.
I've met clergy members, I'vemet high-functioning people that
have all fallen intohomelessness through various
paths, and so having thatkindness and empathy is very
fundamental in how to interactwith a lot of these patients.
These patients are already here.
(11:26):
This is our issue.
This is a health care issue andwe can't shirk our duty here.
Speaker 4 (11:32):
And I would just add I think that our care delivery
pathways we have to be creative,we have to be thinking outside
the box and thinking about howwe can deliver care differently
for patients.
That includes how we train ourcaregivers and the experiences
that our caregivers have and whoyou know may be traditionally
expert.
(11:52):
Quote unquote of a team, of amedical team like that, and we
maybe we flip that on its head.
You know, and everybody's kindof ideas and thoughts are really
important.
Speaker 2 (12:03):
You're impacting a lot of lives in this area and
doing really good work in theprocess.
I would have to assume you'vegot some amazing stories of
differences you've made inpatients' lives.
Is there one that you couldshare with us?
Speaker 1 (12:16):
There are so many that I can come to mind one
being a family at the HopeCenter, and the story kind of
speaks to the humble nature ofmany of our patients.
I was leaving the Hope Centerafter a clinical session.
I had a gentleman stop me andask me hey, can you refill my
meds?
I said, sure, give me a list,we'll get you up and to be seen.
(12:36):
And from that very minorinteraction spiraled up to
understand his complex medicalhistory, his six months in a
hospital in Philadelphia, his 30day prognosis and the absolute
fear he had about his impendingmortality and about how that
(12:59):
affected his middle schooldaughter.
And how that affected, you know, his partner, who had been
living under the radar for years.
His daughter was a middleschooler and she had been in the
school for four years.
And you know, when we finallyunraveled this, when we build
enough trust with these patients, where they open up and share
(13:19):
these, these um dehumanizingstories that they've been
through, we're able to, you know, uh, partner with them.
We're able to walk many ofthese journeys together.
Um and the family madeincredible strides.
The, the gentleman's healthreally stabilized, um stabilized
to the point where he exceededthis 30-day window.
(13:42):
He was given and had veryconflicting emotions about it
that were ultimately verypositive.
But the family left the HopeCenter into stable housing and
continues to be housed to thisday, over a year later, which
speaks to the idea that whatthey needed was just a little
bit of partnership, and it was areal pleasure to walk that
(14:07):
journey with them.
Speaker 3 (14:08):
You talk about partnership.
This sounds a little bit likeit needs to be a two-way street
for not only you to be able toreach out and get them to also
reach out to you as well.
How do you do that?
Speaker 1 (14:22):
One of the strategies that's been shown most
successful in working with adisenfranchised group is the
idea of goal-negotiated care,meaning a patient sets a goal
for themselves which becomes theoverall goal for the healthcare
team in all of its domains themedical providers, the social
worker, the nurse case managers,et cetera.
The healthcare team in all ofits domains the medical
providers, the social worker,the nurse case managers, et
(14:46):
cetera.
Whatever that goal is, it'spatient defined, meaning they
have their buy-in to it.
Many times, our role is tooffer anything that we can do to
help eliminate barriers in thisregard and then set
expectations for the patient tohelp themselves as well.
Obviously, every goal, everystep can be renegotiated.
Pitfalls befall other pitfalls,but that is that's part of the
(15:11):
journey that we have with eachindividual patient.
Speaker 4 (15:14):
I would say like consistency also, like of us, of
the medical team, of themultidisciplinary team.
You know, to Ben's point, youknow things happen and life
happens to everybody.
But knowing that we're going tobe there at the time that we
said we're going to be, and thatyou know, if it takes 10 tries
to get this figured out or tocome see us or for us to have a
(15:36):
complete medical visit, that inour you know, in our medical
opinion, like that's okay and Ithink that that helps people
feel you know, there's not,there's no real downside to this
.
It's really like how you wantto engage and how you want your
care, and when you're ready,we're ready, and it kind of, you
know, it kind of takes thatpressure off, I think.
Speaker 2 (15:58):
Where do you see this going?
Where do you hope this programand the work that you're doing?
Where do you hope that's goingto be in the 5-10 years?
Speaker 4 (16:06):
Yeah, I'm hopeful for continued like community
partnerships so that we canreally make sure that we're, you
know, capturing the voice ofthe community and the needs of
the community to be able toprovide services in the way that
patients are hopeful to havethem.
I think Friendship House is agreat example.
Also, there's a mobile vanconsortium through Delaware
(16:27):
that's actually run through theUniversity of Delaware and the
Delaware Food Bank, and so thisis an opportunity for various
mobile vans in the state to cometogether to understand resource
availability, to understandstrategy and what's worked and,
you know, to learn more.
So I think, for all thosereasons, our community
(16:48):
partnerships are tremendouslyimportant and, again, because
typically these organizationsmay know how to serve patients
best, you know in things, again,that we're not expert in, but
that we know our patients need.
So I think that you knowthere's more, only more to learn
and more partnerships to reallycome from that.
Speaker 1 (17:12):
The dreamer in me knows that there is a.
This is a field where,hopefully, none of us ever will
have to work eventually.
But, being more pragmatic, thegrowth here is of scale.
It's of scale in both services,delivered locations, delivered
patients that are able to beinputted into the system, and
(17:35):
then ultimately building alarger network that includes
stable housing, stable permanenthousing, which requires a lot
of state and federal buy-in,like you referenced.
Ideally, we would have morepeople reaching out to the
communities in need, enteringcommunities in need, being
invited to connect with patients.
(17:56):
Patient engagement is alwaysone of the hardest issues for
this population, because theunhoused, rough sleeping
population has learned to beinvisible as a survival
mechanism, and so being able tofind these communities where
they exist, show good intentions, show consistent good
(18:16):
intentions, is really crucial tooverall delivering care.
Speaker 4 (18:22):
When you ask about growth of these programs and
development of these programs, Ithink about our medical
students and learners, reallyimportant.
You know that we incorporatethem in the work that we do and
we continue to do so.
You know we need, you know,clinicians and care team members
to help grow this work as well.
So that's one of our goals andmissions is to continue to have
(18:45):
experiences, clinicalexperiences for learners.
Speaker 3 (18:49):
Ben and Ashley.
Thank you both so much for yourtime today.
This certainly is not the lasttime we will be discussing
homelessness on this program.
Thank you, my pleasure.
We'll have more information onthe programs we mentioned today,
such as the Mobile HealthServices, van and the New Castle
County Hope Center, in the shownotes for this episode.
Speaker 2 (19:07):
And don't forget to subscribe to For the Love of
Health on Apple Podcasts orSpotify.
And you can watch the videoversion of For the Love of
Health on Christiana Care'sYouTube channel.
Speaker 3 (19:16):
We'll be back in two weeks with another great
conversation.
Speaker 2 (19:18):
Until then, thanks again for joining us.
Speaker 3 (19:20):
For the Love of health.
These are people, these patients are already here.
This is our issue.
This is a health care issue.
We can't shirk our duty here.
Speaker 2 (00:09):
You're listening to For the Love of Health, a
podcast about delivering careand creating health, brought to
you by Christiana Care.
And now here are your hosts.
Speaker 3 (00:19):
Hello everyone, I'm Megan.
Speaker 2 (00:20):
McGerman and I'm Jason Tokarski.
Welcome to For the Love ofHealth brought to you by
Christiana Care.
Speaker 3 (00:25):
Homelessness can impact both physical and mental
health and make accessingmedical care difficult.
As a result, peopleexperiencing homelessness often
face higher rates of poor healthoutcomes than people with
housing.
Speaker 2 (00:38):
Which leads us to the next question in our Toughest
Questions in Healthcare serieshow can healthcare impact
homelessness?
Joining us today to tackle thatquestion are Dr Ben Golden,
program Director for theChristiana Care Medical Respite
Program at the New Castle CountyHope Center, and Dr Ashley
Panicelli, clinical Director forChristiana Care Complex Primary
Care.
Speaker 3 (00:58):
Ben and Ashley, thank you both so much for being here
today.
Speaker 1 (01:01):
Thank you for having us.
Speaker 3 (01:02):
Yeah, thank you, glad to be here.
What do the local and nationalconversations on homelessness
sound like right now?
Speaker 1 (01:09):
Well, not great at present.
The tone out in the communityright now is one of concern.
In 2023, nationally, there'sbeen an 11% increase in
homelessness and in Delawarealone, it's 9% increase from
2023.
From 2020 until now, there'sbeen a 58% increase in the
individuals rough sleeping outon the street, and I can tell
(01:31):
you that there's been a lot ofconcerns regarding the grants
pass decision, which has removedsome protections from the
Eighth Amendment for thiscommunity.
Historically, manymunicipalities have been
required to provide options forpeople rough sleeping out on the
street, so not sleeping in ashelter, but sleeping in a park
or in a car or out on the streetitself.
(01:53):
If there were shelter bedsavailable, if there were
resources available and patientschose not to take advantage of
them, then they could beticketed, fined or arrested not
to take advantage of them, thenthey could be ticketed, fined or
arrested.
The Grants Pass decision saidthat you no longer have to have
those restrictions, and fining,ticketing or arresting people
(02:17):
sleeping outside does notconstitute as cruel and unusual
punishment.
We've already seen sweepshappen in Philly, in Los Angeles
and in San Francisco, and eventoday I've had patients express
concern about what's going tohappen here when it finally
arrives.
So there's a lot of people arevery nervous about what little
resources they have already.
Speaker 2 (02:32):
How does health care and homelessness?
How do they connect, how dothey affect each?
Speaker 1 (02:38):
other.
So there are many responses tothis question.
I think, pragmatically, thesepatients have medical illnesses.
Patients who are experiencinghomelessness have been shown to
have 3.5 times the mortalityrate associated with their
homelessness than their housedcounterparts.
A 40-year-old homeless patienthas a similar mortality risk to
(03:02):
someone who's nearly 20 yearsolder.
So independently based on thehousing status.
So these people have medicalillnesses, they have risk
factors and, pragmatically,they're already in the offices,
they're in the emergencydepartments, they're in the
hospital.
Like this becomes an issue thatwe have a patient in front of
us, we should take care of themand, like any other risk factor
(03:25):
for healthcare, for medicine,these things are modifiable.
Just like when we talk aboutsmoking with heart disease,
affecting a person's housing canreduce their comorbidities.
So providing housing forpatients, working on housing for
these patients, is a medicalintervention that can be done
(03:46):
for them to have long-termbenefit, but it has to be a
long-term solution.
Speaker 2 (03:50):
And I would assume there's also got to be an angle
of the care that can be providedto someone who is homeless is
different because of what youcan offer them for those
treatments.
Speaker 1 (04:02):
Absolutely, as we've found in our time working with
the mobile clinic.
The strategy for healthcaredelivery has to be unique,
because these patients' journeyand medical conditions are
unique.
These patients don't haveplaces to store medications,
they don't have ready access tothings like bathrooms, so if you
have a person on a diuretic ora person on insulin, they have
(04:24):
no place to regularly use therestroom or refrigerate their
insulin.
So you have to be more creativeabout these things.
In addition to this, many ofthese patients have severe
comorbidities.
One in five have a communicabledisease.
Two of three meet criteria forsevere mental illness, when it
exists.
Most patients have been exposedto violence and hunger.
30% reported substance usedisorder, and so you have to be
(04:48):
able to tailor a lot of thetextbook healthcare delivery to
their unique environment.
We'll have five patients with asimilar complaint, but we'll
have five different strategies.
Speaker 3 (04:59):
Let's talk more about what ChristianaCare is doing to
directly find this and helpthis population.
You've mentioned the mobile van, the mobile health services van
, of which, ben, I know you arethe lead physician on the van
that's based in Wilmington.
Talk about how that works, howpeople can find you and really
the purpose of this van.
Speaker 1 (05:20):
Our vision has really morphed over the year that
we've been out doing this andwe've had great expansion.
We now have seven sites aroundthe greater Wilmington area.
Patients can find us a varietyof ways.
We are setting up hotlines forpeople to call in to find out
where we are that day at thattime and we're working to
increase services so that we'reout every single day, not just
(05:42):
twice a week right now.
Speaker 4 (05:43):
And we really partner .
You know, and are continuing tolearn and evolve in this
process and learn you know whoour community partnerships are
and to help best serve communitymembers.
You know, I think one of thegreat things about this is maybe
we went in and our partnerswent in with ideas of where
would the best places to be andhow to best serve patients, and
(06:03):
then you know we're learning andmaybe a community member from a
community organization isreaching out and saying, hey, I
have, you know, a lot of maybeparishioners or people coming to
my community center who needhelp or from different you know
types of organizations and areasking for us to partner, and
it's been really great.
We can kind of pivot and figureout who to best partner with to
(06:26):
help you know the patients thatare most in need and, quite
frankly, maybe the most unlikelyto come to some of our brick
and mortar practices, which is,I think, the most rewarding part
and our favorite part.
Speaker 3 (06:38):
Your team also does a lot of work in the Newcastle
County Hope Center.
Talk to us about that.
Speaker 1 (06:44):
The Newcastle County Hope Center is a large
transitional living facilityhoused in the old Sheraton on
Airport Road just outside ofWilmington.
Christiana has partnered withthem since they opened to
provide healthcare services onsite.
A few years ago we establisheda 36-bed medical respite program
.
We're the first and onlymedical respite program in the
(07:06):
state of Delaware.
We provide services to patientsthat have complex health care
needs but don't require fullhospital level of services.
So we accept many patients fromthe hospital that require a
little bit more care, and beingout on the street or being in a
shelter would be detrimental tothe healing that's already
occurred.
We have a very dynamic modeland a multidisciplinary model to
(07:28):
try and connect with multipledomains within the social
determinants of health, medicineand healthcare being sometimes
a smaller portion of some oftheir overall needs.
Speaker 2 (07:37):
Obviously, the goal is for any patients that you're
seeing not to be stuck in thissituation forever.
So do you have any proceduresthat you go through to try to
help someone transition from theHope Center, maybe to then
being out elsewhere, so thatthey can receive services from
the mobile van and maybe eventhen to the brick and mortars,
as you say?
Speaker 4 (07:57):
Yeah, that's something that in complex
primary care we're reallythoughtful about and always kind
of shifting and changing andare very dynamic in that both
our clinicians and ouroperational team about how our
you know, our spaces really fittogether best.
Because we do have multiple, youknow, patient stories of
patients who may go frominpatient setting at the
(08:19):
hospital, who then maytransition to the Hope Center
and then, once they're, you know, able to leave the Hope Center.
We understand and value thatthey still need that primary
care and are going to needongoing management and they may
be able to transition maybe tothe mobile van or to one of our
brick and mortar practices.
And I would say we're stilllearning, but we're trying to
make workflows and strategies toreally best connect patients in
(08:43):
a streamlined fashion so thatthey know that, you know,
despite this next transitionpoint, their health care is
still going to be managed andthey're still going to be able
to get what they need.
Luckily, some of our clinicianscross different spaces, which
is a really valuable thing, Ithink about our group, but even
not if not, we have greatcommunication between our teams
and between our differentlocations.
Speaker 3 (09:05):
Ben, earlier you mentioned social determinants of
health.
How do you dig through that?
I know, Ashley, a lot of thepractices that you work with now
are doing social determinantsof health screenings.
Are you also doing thosescreenings as you meet with
these patients?
Speaker 1 (09:20):
Ours has a little bit more of an organic feel to it
at the moment because many ofthese things come up in
conversation.
Sometimes people will enterinto the mobile van not because
they want to be seen by aprovider, but because we have
bottled water, because we havesnacks, we have hand warmers,
things like that, and so a lotof these discussions happen
because that is their presentingneed and we're trying to
(09:42):
capture more of the formal datato truly understand the needs of
our various communities, ourseven sites.
Speaker 4 (09:48):
And I would say that's one of the things that
we've really kind of evolvedwith our work on the mobile van
is, you know, we had one visioncoming in of this is how we
would care for these patientsand this is what we should do.
And then we learned, oh,actually, you know, we really
need to pivot.
We're excited to talk to youabout your preventative health
and your chronic disease, butthat may not be first thing on
(10:08):
the list, and so when we'rereally thinking about the mobile
van and what we have access toand the work that Dr Golden is
doing is, let's really shiftthat priority list around,
because it may look different inthis setting than it does in
maybe one of our brick andmortar practices, and that, you
know, is something that we're isconstantly evolving, based on
season, based on location thatwe're in, and so something that
(10:31):
you know we take in ouroperations team takes, you know,
takes a lot of our time andwhat we're what we're really
thinking about.
Speaker 3 (10:38):
What do you want someone to understand about the
population that you're workingwith?
Speaker 1 (10:43):
These are people.
People experience homelessnessand it's complicated and it's
messy, but at the end point,even if we can't solve a very
complex issue in the immediatemoment, we can always be kind
and we can always have a senseof empathy.
The studies show that there isa large portion of this country
(11:05):
that is at threatenedhomelessness and threatened
housing insecurity.
I've met people with doctoraldegrees.
I've met clergy members, I'vemet high-functioning people that
have all fallen intohomelessness through various
paths, and so having thatkindness and empathy is very
fundamental in how to interactwith a lot of these patients.
These patients are already here.
(11:26):
This is our issue.
This is a health care issue andwe can't shirk our duty here.
Speaker 4 (11:32):
And I would just add I think that our care delivery
pathways we have to be creative,we have to be thinking outside
the box and thinking about howwe can deliver care differently
for patients.
That includes how we train ourcaregivers and the experiences
that our caregivers have and whoyou know may be traditionally
expert.
(11:52):
Quote unquote of a team, of amedical team like that, and we
maybe we flip that on its head.
You know, and everybody's kindof ideas and thoughts are really
important.
Speaker 2 (12:03):
You're impacting a lot of lives in this area and
doing really good work in theprocess.
I would have to assume you'vegot some amazing stories of
differences you've made inpatients' lives.
Is there one that you couldshare with us?
Speaker 1 (12:16):
There are so many that I can come to mind one
being a family at the HopeCenter, and the story kind of
speaks to the humble nature ofmany of our patients.
I was leaving the Hope Centerafter a clinical session.
I had a gentleman stop me andask me hey, can you refill my
meds?
I said, sure, give me a list,we'll get you up and to be seen.
(12:36):
And from that very minorinteraction spiraled up to
understand his complex medicalhistory, his six months in a
hospital in Philadelphia, his 30day prognosis and the absolute
fear he had about his impendingmortality and about how that
(12:59):
affected his middle schooldaughter.
And how that affected, you know, his partner, who had been
living under the radar for years.
His daughter was a middleschooler and she had been in the
school for four years.
And you know, when we finallyunraveled this, when we build
enough trust with these patients, where they open up and share
(13:19):
these, these um dehumanizingstories that they've been
through, we're able to, you know, uh, partner with them.
We're able to walk many ofthese journeys together.
Um and the family madeincredible strides.
The, the gentleman's healthreally stabilized, um stabilized
to the point where he exceededthis 30-day window.
(13:42):
He was given and had veryconflicting emotions about it
that were ultimately verypositive.
But the family left the HopeCenter into stable housing and
continues to be housed to thisday, over a year later, which
speaks to the idea that whatthey needed was just a little
bit of partnership, and it was areal pleasure to walk that
(14:07):
journey with them.
Speaker 3 (14:08):
You talk about partnership.
This sounds a little bit likeit needs to be a two-way street
for not only you to be able toreach out and get them to also
reach out to you as well.
How do you do that?
Speaker 1 (14:22):
One of the strategies that's been shown most
successful in working with adisenfranchised group is the
idea of goal-negotiated care,meaning a patient sets a goal
for themselves which becomes theoverall goal for the healthcare
team in all of its domains themedical providers, the social
worker, the nurse case managers,et cetera.
The healthcare team in all ofits domains the medical
providers, the social worker,the nurse case managers, et
(14:46):
cetera.
Whatever that goal is, it'spatient defined, meaning they
have their buy-in to it.
Many times, our role is tooffer anything that we can do to
help eliminate barriers in thisregard and then set
expectations for the patient tohelp themselves as well.
Obviously, every goal, everystep can be renegotiated.
Pitfalls befall other pitfalls,but that is that's part of the
(15:11):
journey that we have with eachindividual patient.
Speaker 4 (15:14):
I would say like consistency also, like of us, of
the medical team, of themultidisciplinary team.
You know, to Ben's point, youknow things happen and life
happens to everybody.
But knowing that we're going tobe there at the time that we
said we're going to be, and thatyou know, if it takes 10 tries
to get this figured out or tocome see us or for us to have a
(15:36):
complete medical visit, that inour you know, in our medical
opinion, like that's okay and Ithink that that helps people
feel you know, there's not,there's no real downside to this
.
It's really like how you wantto engage and how you want your
care, and when you're ready,we're ready, and it kind of, you
know, it kind of takes thatpressure off, I think.
Speaker 2 (15:58):
Where do you see this going?
Where do you hope this programand the work that you're doing?
Where do you hope that's goingto be in the 5-10 years?
Speaker 4 (16:06):
Yeah, I'm hopeful for continued like community
partnerships so that we canreally make sure that we're, you
know, capturing the voice ofthe community and the needs of
the community to be able toprovide services in the way that
patients are hopeful to havethem.
I think Friendship House is agreat example.
Also, there's a mobile vanconsortium through Delaware
(16:27):
that's actually run through theUniversity of Delaware and the
Delaware Food Bank, and so thisis an opportunity for various
mobile vans in the state to cometogether to understand resource
availability, to understandstrategy and what's worked and,
you know, to learn more.
So I think, for all thosereasons, our community
(16:48):
partnerships are tremendouslyimportant and, again, because
typically these organizationsmay know how to serve patients
best, you know in things, again,that we're not expert in, but
that we know our patients need.
So I think that you knowthere's more, only more to learn
and more partnerships to reallycome from that.
Speaker 1 (17:12):
The dreamer in me knows that there is a.
This is a field where,hopefully, none of us ever will
have to work eventually.
But, being more pragmatic, thegrowth here is of scale.
It's of scale in both services,delivered locations, delivered
patients that are able to beinputted into the system, and
(17:35):
then ultimately building alarger network that includes
stable housing, stable permanenthousing, which requires a lot
of state and federal buy-in,like you referenced.
Ideally, we would have morepeople reaching out to the
communities in need, enteringcommunities in need, being
invited to connect with patients.
(17:56):
Patient engagement is alwaysone of the hardest issues for
this population, because theunhoused, rough sleeping
population has learned to beinvisible as a survival
mechanism, and so being able tofind these communities where
they exist, show good intentions, show consistent good
(18:16):
intentions, is really crucial tooverall delivering care.
Speaker 4 (18:22):
When you ask about growth of these programs and
development of these programs, Ithink about our medical
students and learners, reallyimportant.
You know that we incorporatethem in the work that we do and
we continue to do so.
You know we need, you know,clinicians and care team members
to help grow this work as well.
So that's one of our goals andmissions is to continue to have
(18:45):
experiences, clinicalexperiences for learners.
Speaker 3 (18:49):
Ben and Ashley.
Thank you both so much for yourtime today.
This certainly is not the lasttime we will be discussing
homelessness on this program.
Thank you, my pleasure.
We'll have more information onthe programs we mentioned today,
such as the Mobile HealthServices, van and the New Castle
County Hope Center, in the shownotes for this episode.
Speaker 2 (19:07):
And don't forget to subscribe to For the Love of
Health on Apple Podcasts orSpotify.
And you can watch the videoversion of For the Love of
Health on Christiana Care'sYouTube channel.
Speaker 3 (19:16):
We'll be back in two weeks with another great
conversation.
Speaker 2 (19:18):
Until then, thanks again for joining us.
Speaker 3 (19:20):
For the Love of health.
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