In the “Show Me State” of Missouri, a Community Health Center in the city of St. Joseph showed everyone just how to pull off a miracle. With just $42,000 in their budget, and more than just a few skeptics who said there wasn’t enough money or time, the determined staff at Northwest Health Services opened a clinic for the homeless. They said it couldn’t be accomplished, but it was – in just 27 days.
It happened in 2017, after a local homeless clinic decided to close shop, leaving the city’s growing numbers of displaced without options for care. The timing could not have been more urgent. A season of heavy rains and flooding created a crisis for the homeless who were living in tents and campers along the banks of the Missouri River. Many temporary homes were washed out, along with the residents’ belongings. People had no place to go beyond the streets or local shelters. Christmas was a little more than one month away. Temperatures were dropping. Rodney Hummer, Director of Development and Community Engagement at Northwest Health Services, decided on an action plan.
“Six months before this happened we secured a building just for storage. We rented it for $500 a month. It was a perfect location, by the bus station, Salvation Army, Open Door Food Kitchen and other places that might offer homeless services. So when the news came down about the clinic, we told the board and our leadership that we will do this in 30 days.”
Certainly there were doubters, particularly when it came to money. Cost estimates showed they would need at least $250,000 to transform the storage building into a clinic space. There was also the matter of getting the city to approve the permit. Someone even had to design the layout. No problem. With the clock ticking Rodney designed the blueprint himself on a CAD software program and requested a speedy approval with the city planning board. The project was approved immediately. Then it was time to actually build – and time was running out.
“Luckily, we had a contractor step in, Lehr Construction,” recalled Hummer. “They knew Northwest Health Services well and our passion for serving the underserved. We had to essentially gut a building and rebuild it up to code, including walls, ceiling, IT, electrical wiring, and lighting. There were a lot of late nights and tense moments. Every day we had a list of things to get done, and a list for the evening volunteers to get done. The first night 19 volunteers showed up. We even had some of the homeless people come help. We had a nurse practitioner helping, our CEO, staff from dental, medical, behavioral health, development, H.R, lab, kids of our contractors, several of our community health workers/ I even coerced my wife and my dad to help. One nurse practitioner from a remote rural clinic two hours away said ‘I can’t be there to help, but I believe in what we’re doing. I’m buying pizza for the volunteers.'”
Local businesses and organizations also donated supplies and labor: Lowes, Habitat for Humanity, Home State Health, Lehr Construction, Caples Creek Properties, Waldinger Construction. Hummer estimates that 500 hours of volunteer efforts donated by Northwest Health Services staff, community members, and homeless patients were also invaluable.
“I seriously doubt that at the time of construction, the donors and volunteers understood that their labor would save lives and impact the community like it has,” he adds.
On December 15, the first day the center opened its doors, patients crammed into the 10 ft. by 10 ft. waiting room.
According to Tiffani Bradbury, a Family Nurse Practitioner on staff, 90 percent of the patients who enter the doors of the center have both medical and behavioral health needs. Many patients are casualties of the opioid epidemic or are mentally ill – people whose lives descended into chaos after they could not access mental health facilities or medications. “We have patients who suffer from bipolar disorder or schizophrenia, who hear voices in their heads. You can’t just tell them to go get a job. They can’t even function without medication.”
Bradbury’s descriptions of patient encounters offer an instructive snapshot of the nature of homelessness and the multitude of factors that may unravel a life and force someone into the streets.
“Homelessness is so multifaceted, the complexities of it require responses in multiple areas,” she said. “Many of the people who come to us have dental issues, mental illness, no housing, transportation, a place to bathe or regular access to food. And they come in with health conditions that have gone untreated for years. We have an amazing staff here who may not have a specific job title but help untangle all the threads that bind people into homelessness, who are essentially problem-solvers.”
The health center operates a grant-funded dispensary that gives out free prescriptions and a caseworker who can help connect patients to a psychiatrist, housing or other services. There’s also a Community Health Worker and a Patient Access Coordinator who, in addition to Bradbury and other dedicated staff, go beyond the reach of simple health care and help people get their lives back together and off the streets.
“When they come in I check their basic health care, but it’s much more than that,” said Bradbury. “Many people who come in don’t have an ID, which is what people need to apply for housing, social security or disability. Getting them a hotel room for the night is only a short-term fix. We have people who can help them get their IDs, birth certificates, and the paperwork needed to get them into housing, social services or Medicaid. We have people who served in the military but did not realize they were eligible for benefits because they thought they had to be deployed into combat in order to receive them. We have staff members who help with that as well.”
Hummer, a former combat medic who served in the Gulf War, says the center is looking to hire a veteran liaison to better facilitate services for displaced veterans. But the center is fast becoming a one-stop-shop for many services and referrals that include primary care, behavioral health, and substance abuse counseling, Medication-Assisted Treatment, casework, Hep C treatment, HIV and AIDS related services. The health center gives out 350 bus passes a month to patients so they can access specialty care and other services across the town. If a patient comes in hungry or cold, usually there’s something to eat or an extra coat or mittens available. One health center staff member hauled a futon across town for a patient who finally found affordable housing but had no furniture. Even patients who find their way off the streets come back to lend a hand and pay it forward. Bradbury said last week a former patient dropped off a crate of fresh fruit at the doorstep.
“People who come here and get help, come back and help once they are on their feet,” said Bradbury. “Everything is connected and we are making a huge difference in people’s lives.”
That difference has paid off. In the first year alone Emergency Room visits among the homeless population for that zip code were reduced by 730 admissions. “If you take that times $1,917 for the average cost of an ER visit, that equates to $1,399,410 in savings to our health care system,” said Hummer. “This is population health at its best.”
Still, there remains more work to be done, with more services and staff to add. There’s also a wish list. Hummer remains undeterred, “When passionate people come together to create a positive change, anything is possible,” he said.