Health Care Without Walls provides compassionate, comprehensive, and gender-specific health care and care coordination to homeless and marginally-housed women and families.
Our volunteer medical team is comprised of seventeen physicians and one physician’s assistant, and together, they donate hundreds of hours of free medical care each year at Boston area shelters. They come from nearby hospitals and represent Internal Medicine, Pediatrics, Family Medicine, Ob-Gyn, Dermatology, Emergency Medicine, and Psychiatry.
The backbone of our organization is our nurse case managers and community health workers who work alongside our volunteers. Our care is personalized and tender and includes diagnostic tests, treatment of acute and chronic conditions, referrals, education, and counseling. We never bill for our clinical time. Our clients range from one day old to women in their nineties, and all of them are bound by the common need for human kindness–given without red tape, bureaucratic hurdles, or stigmatization.
Our medical teams operate clinics at two Boston area shelters for adult women—Rosie’s Place and Women’s Lunch Place. Guests receive immediate and free walk-in medical care.
By the numbers, adult women receive the most benefit from our programs. In 2015, HCWW served 1,863 women, of whom more than 600 were over the age of 60. This is nearly double the number of elderly women served in 2014. Most of these women have at least one serious health condition, which is not surprising given the national statistics: 84% of homeless women report at least one serious health condition, and 5 times as many develop chronic diseases like diabetes, hypertension and heart disease in comparison to those who are not homeless.
Bridges to Elders provides care in coordination with dedicated staff and volunteers at the Women’s Lunch Place for women who are 60 or older. With the support of a dedicated community health worker, these women benefit from a higher level of care coordination and monitoring to enable and encourage them to take steps to find housing and improve their situations through improved health.
Bridges to Elders has seen promising results and has received national attention. During the first half of 2015, emergency room visits dropped by 86% and inpatient stays by 77% for women in the program.
Our Family Programs serve women and their families who are experiencing homelessness or living in dire poverty. Our medical teams operate clinics in three shelter facilities and safe houses of Casa Myrna, which house victims of domestic abuse. We have opened a new clinic in Framingham to serve the shelter community in the Metrowest area operated by the Southern Middlesex Opportunity Council, and we have an ongoing relationship with the Middlesex Human Service Agency and Mary’s House in Waltham.
The largest growing segment of the homeless population is families. In the second half of 2016 alone, nearly 4,500 families applied for assistance in the Massachusetts’ Emergency Assistance shelter program, and more than 2,000 of those families were placed in a shelter. This number does not include those families who are doubled up, living in unsafe conditions, or sleeping in their cars. Homeless families face significant instability and trauma, and homeless children have higher rates of asthma, obesity, and nutritional deficiency, and are more likely to experience acute and chronic illness. In addition to our usual general care and care coordination, our team offers developmental assessment for children and parenting education for mothers and expectant mothers.
In 2016, we launched our new Bridges to Moms program, an innovative program modeled after our successful Bridges to Elders program. Offered in partnership with the Brigham & Women’s Hospital Ob-Gyn services, this program offers comprehensive support as these mothers navigate motherhood in the most challenging of circumstances. Our community health workers and nurse practitioners help mothers and expectant mothers who are homeless or living in dire poverty coordinate care for themselves and their children. They monitor the well-being of both mother and infant, ensure that proper medical care is schedule and followed, and provide a range of support including infant care, nutrition guidance, food assistance, transportation to medical appointments, and finding housing suitable for a new family. We believe this care will lead to better outcomes for mother and infant, and initial results are positive – 76% of pregnant moms in the BTM program are attending their prenatal appointments, compared to an average of less than 10% for the typical pregnant homeless population.
Operating in a region of so many prestigious universities, HCWW is proud to be a host site for community service electives for medical and nursing students, pre-meds, medical residents, and students of other allied health professions.
Using a curriculum created and published by HCWW to address the unique challenges and medical needs of homeless women, we prepare clinicians-in-training to be compassionate caregivers who are skilled at meeting the needs of the underserved. Our interdisciplinary training program is a popular elective for students and is held collaboratively with the Regis College Center for Health Sciences and Harvard Medical School.
We also use our own clinical experience to track and evaluate the impact of our care on those we serve. Our research studies examine how free care for the under-served can be financially advantageous to our communities, and we present at national and international conferences. It is our goal to inform health care policy at institutional, local, and national levels.
Going forward we envision continuing our work of creating a more responsive, comprehensive, collaborative and sustainable system of care.
We will provide fundamental bridge or ‘gap care’ on an individualized basis by determining what needs are not being met and what services are either unavailable, or not easily accessible, to our clients as they move beyond the shelters, beyond helplessness and hopelessness to improved health and health literacy.
As U.S. healthcare moves towards the concept of global payments, we believe Health Care Without Walls will set the standard of health care for the underserved that is based on our model of caring, connecting and community service.