On the Job Providing Healthcare to the Homeless

homeless healthcare nurses


Though there’s great news on our effort to prevent and end homelessness, with recent stats showing a 42 percent drop since 2008, there’s still a homeless population that needs support. County, faith community and nonprofit partners come together to help those in need; for example, the winter hypothermia program.

But wherever people who are homeless need help … in a tent in the woods, under a bridge, in a car … three nurse practitioners with the Health Department are on the job. They are part of the Health Department’s Homeless Healthcare Program (HHP) started in 2006 to provide street outreach to the county’s unsheltered (nearly 1,200 by recent count).

“Many of the people we visit are slightly wary of strangers and suspicious of government,” says Lori McLean, the central county nurse practitioner and HHP coordinator. Coaxing, listening, patience — and even bringing a man a sandwich (and one for his dog) — are some of the strategies that help workers build that trust.

homeless healthcare provider quote

Trust has to be earned and it starts by treating the homeless with respect and dignity. The nurse practitioners, McLean, Rieta Scott and Karen Wood, coordinate homeless outreach teams. These include a Project to Assist Transition from Homelessness (PATH) worker with the Fairfax-Falls Church Community Services Board, a peer advocate and an outreach worker with a community-based organization.

Each client is assessed for physical and behavior health care needs and offered opportunities to access existing county services, be it emergency shelters, dental or medical care, housing or food vouchers, job placement, alcohol and substance abuse treatment or mental health counseling. Helpful supplies — granola bars, water bottles, hand wipes, first-aid kits, emergency blankets in the winter and bug spray in the summer — are handed out.


Small and Large Victories

The teams go out in the field once a week and make their rounds visiting familiar clients and discovering new ones. “The team usually has to engage clients multiple times before a person will trust them enough to accept services or treatment,” notes McLean. “It’s important to keep in touch, keep the lines of communications open. Just having someone say they are considering utilizing services can be a small victory.”

And there are larger ones. Scott tells of a man who lived under a bridge for 15 years. Suffering from a thyroid problem and prone to fits of paranoia, he was reluctant to even step foot into a shelter to accept help. Once she was able to earn his trust enough to treat him, his whole outlook changed and after a time he was able to get into permanent housing.

Teams are often called upon by the Office to Prevent and End Homelessness, which receives public safety requests from the public who have spotted someone living in a car or in an outdoor area. During the rest of the time, the nurse practitioners can be found at drop-in sites (such as the Lamb Center in Fairfax, at the First Christian Church in Falls Church, the Bailey’s Crossroads Community Shelter, Embry Rucker Shelter in Reston and the Gartlan Center in Mount Vernon) where clients go for food, rest, resources. Some sites have laundry and shower facilities. They also provide services at family and singles shelters throughout the county.


Helping Hundreds

Fairfax County is home to the second largest number of people without homes in the region; only Washington, D.C, has more. In FY 2015, outreach workers engaged with 411 clients a total of 1,107 times, while the nurse practitioners saw 463 unduplicated clients in 902 visits for 1,160 different conditions.

Many clients are dealing with psychiatric and substance abuse problems in addition to chronic health conditions. Some need simpler care — dressings changed or medicines administered. During winter’s frigid winter months, a hypothermia prevention program operates throughout the county to provide safe, warm space for those who are homeless. Nonprofits and churches serve as host sites. The outreach teams make regular visits to the shelters to offer free flu shots and check for other illnesses that might crop up.

The care that is offered is crucial and the rewards significant. “We meet wonderful people with wonderful stories,” says McLean. “And they know we are thinking about them.”

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