It’s well-known that the inconveniences of treatment and recovery often hinder access to appropriate medical care. Among individuals who are homeless, these challenges make access to care nearly impossible, as the daily search for food, clothing, and shelter takes priority over preventive and acute care. The logistics of medical screening and treatment—including preparing for a colonoscopy or storing maintenance medications—become untenable barriers and burden the homeless and other at-risk populations with illnesses and injuries that can rapidly escalate to life-threatening (and costly) emergencies.

Through an innovative initiative funded by North Shore Medical Center, the Lynn Community Health Center/Bridgewell Recuperative Care Center has been created to break this cycle for homeless patients on the North Shore. The 14-bed facility is a collaborative community effort, managed by residential housing provider Bridgewell in partnership with Lynn Community Health Center, North Shore Medical Center, Partners HealthCare, My Brother’s Table, The Massachusetts Coalition for the Homeless, and the Lynn Health Task Force. Its core philosophy is simple: provide a place for transient individuals to prepare for procedures or recover from illness or surgery, and set them on a more stable trajectory toward prevention and treatment adherence. In turn, the center helps reduce Emergency Department visits, hospital admissions, complications, and poor outcomes—and the associated preventable costs that result.

The center expects to see up to 300 admissions each year. Potential patients are identified by the Lynn Community Health Center Medical Outreach Program, North Shore Medical Center, and other providers. To receive services, patients must lack suitable housing; need an environment in which to prepare or recover; and be sick enough to require more than a simple shelter can provide. Common conditions treated during patient stays, which average one to two weeks, include orthopedic injuries, wounds, chronic diseases such as diabetes, substance abuse, and contagious illness such as the flu.

Residential services at the center are provided by Bridgewell; patients can move between the center and the community as needed, with Bridgewell facilitating placement into temporary or permanent housing as appropriate. The Medical Outreach Program also helps manage patients’ integration into primary care—with the hope that proper care becomes sustainable.

“This is an incredible story of collaboration among community partners with a shared focus on the complex health challenges facing our most vulnerable patients,” says Gargi Cooper, NP, the nurse practitioner responsible for overseeing the medical care of the patients. “Our hope is to set a better trajectory that leads to better outcomes for homeless individuals.”

Topics: Community Partnerships, Behavioral Health, Access to Care

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