Meeting Patients Where They Are:
Street, Shelter, Home and Clinic
Unsheltered persons experience living in a perpetual state of crisis and face multiple barriers to receiving traditional health care—both real and perceived. Physical disabilities, pets, possessions, feeling unwelcome, poor hygiene, fear of indoor spaces, fear of other people, shame around their current status and more can all limit access to health care spaces. In addition to barriers, they often must prioritize immediate basic needs of where they will find their next meal, restroom, or place to sleep over attending to their physical health.
Meeting patients where they are means:
- Literally: Go to wherever they are and bring health care and hope directly to them–at their encampment, car, sidewalk, park, beach, or shelter.
- Figuratively: Greet them in whatever shape they are in with a listening ear, show respect, and stay the course. Earn their trust and keep coming back.
It is a privilege when an unsheltered person invites you into their personal space for simple interactions such as a conversation, an opportunity to provide care, or a chance to deliver essential survival items. Something as routine as placing a blood pressure cuff on a patient’s arm is an opportunity to hold someone’s hand for a human touch. Remember to ask them to tell their story and to listen to what they say. This is where and how the journey begins.
Figure 10. Dr. King tends to a wound in the field. Taken by Margaret Molloy.
Key considerations of access to care for unsheltered persons include:
Location—Introduce patients to primary health care by going to the settings where they already are, as alternatives to the hospital emergency room and traditional clinic. Consider where the person would be most comfortable getting care—the sidewalk, a co-located clinic at a homeless service agency/shelter or inside a traditional clinic setting.
Field Preparation—Prepare in advance to enter each person’s personal and physical space with the necessary attitudes, trust-building tools, safety practices, medical equipment, resources and more.
Quality Patient-Centered Care—Provide the highest quality care using evidence-based practices, tailored for use outside the clinic walls, in the settings best suited to meeting individual needs and patient preferences.
Partnerships and Collaborations—Commit to an integrated medical/social care team model where social care partners are present for the initial patient introduction, ongoing collaborative teamwork, and care management throughout the journey.
Flexibility and Changes in Patient Settings—Take into account that the preferred location of care may change during the process of housing and shelter attainment and readiness. For example, a newly housed patient or resident of a board and care home may prefer to be seen in their residence or may opt for the privacy offered in a traditional clinic setting.
Specialty Care, Laboratory Tests and Pharmacy—To achieve quality and continuity of care, many patients will eventually need to navigate the traditional medical system for services which can only be provided within the clinic walls. Build trust and break down barriers for unsheltered patients so that they become more comfortable coming indoors for care that is not feasible in the field.