Pulse
Clinics for the Homeless Fear GAMC End
Leaders of the Health Care for the Homeless programs in the Twin Cities metro area are bracing for the March 1 termination of General Assistance Medical Care (GAMC), a state health insurance program for some of the poorest Minnesotans.
Hennepin County’s program provides primary care in 11 shelters and drop-in centers and treats between 7,500 and 8,100 patients a year. About 20 percent of its funding comes from GAMC reimbursement, according to Allain Hankey, public health area manager for Hennepin County.
A program run by West Side Community Health Services provides medical care at seven sites in St. Paul, logging about 6,000 encounters per year. Program director Helene Freint says about 30 percent of its billings come from GAMC.
Freint is concerned not only that ending GAMC will eliminate a source of revenue but also that it could increase demand for services. “We’re concerned about how we’re going to manage the capacity,” she says, explaining that the economic downturn has already increased the patient load at their clinics.
Cathy ten Broeke, who directs the Hennepin County Office to End Homelessness, says members of their street outreach team are already seeing people weaning themselves off their psychotropic medications because they know they won’t be able to afford them once the GAMC program ends. “These are already the most vulnerable people in our community,” she says. “To cut them off of their health care is a nail in their coffin.”—Kim Kiser
A Place to Heal
Cathy ten Broeke is trying to make stories like the one she heard about a homeless woman who broke her ankle a thing of the past. Rather than discharge her to the streets after treating her, the woman’s doctor admitted her to the hospital for nine days. “At $1,000 a day, that’s $9,000 for a broken ankle,” says ten Broeke, who directs the Hennepin County Office to End Homelessness. “That’s a really inefficient way to spend public dollars.”
In order to better serve homeless patients and save money, ten Broeke is leading an initiative to establish an intensive medical respite center in Minneapolis. The 10-bed unit would provide 24-hour nursing care for patients who are ready to leave the hospital but still need care at a fraction of the cost of a hospital stay.
Ten Broeke estimates the cost of one bed in a unit providing high-level care would be approximately $4,000 per month. “Medical respite has been a nationally recognized best practice both for getting people the care they need and not spending an enormous amount of money in ways that aren’t as efficient as they could be,” she says.
The Health Care for the Homeless projects in the Twin Cities have been providing respite care for patients with relatively low-level medical needs for a number of years. In St. Paul, West Side Community Health Services’ program maintains four respite beds—two at the Catholic Charities Mary Hall facility and two at Union Gospel Mission, according to program manager Helene Freint. Hennepin County’s program just added two beds to its 18-bed respite ward at the Salvation Army’s Harbor Light Center. It also provides some respite services at the People Serving People shelter, says Allain Hankey, public health area manager for Hennepin County.
“These are for individuals who may have broken bones, frostbite. They don’t need a high level of medical care, but they need a place to heal, and at most shelters you have to be out from 7 a.m. to 7 p.m.,” she says.
To get more homeless patients into respite care, the Office to End Homelessness recently hired a discharge planner who works two days a week at Hennepin County Medical Center.
Ten Broeke is currently seeking funding for the intensive medical respite center, which she and others hope to have up and running in the next four to five months.—Kim Kiser
A Stretched Net
The economic downturn has led to painful layoffs and cutbacks at many Minnesota hospitals and clinics as patients have opted to delay care. But at free clinics and programs for the uninsured, business is booming.
St. Mary’s Health Clinics, which provides free medical care to the needy at locations across the Twin Cities, has added 1,500 appointment slots in the east metro. And demand in the western half of the Twin Cities has increased by almost 50 percent, according to the nonprofit’s executive director, Barbara Dickie. The result is longer wait times for appointments. Dickie says St. Mary’s has seen another change as well: an increase in the number of patients who’ve lost insurance because of a job loss.
Demand for free care is also strong at the Phillips Neighborhood Clinic in Minneapolis. About a year ago, the clinic, which is staffed by University of Minnesota health professions students, extended its hours from one night a week to two and doubled the number of patients as a result. “The need is there,” says medical director Brian Sick, M.D. “I’m confident that if we opened more nights a week, we’d fill them.”
Although the clinic has traditionally served the uninsured, Sick has noticed that they are now seeing more patients who have insurance but can’t afford their copays. He describes one patient who has multiple chronic illnesses who comes monthly to the Phillips clinic. “He makes just enough money to not qualify [for state insurance programs] but not enough to be able to afford his medications,” Sick says. “We do the best we can, but he’s certainly not being cared for in the way he should be.”
Bill Gray, communications manager for Portico Healthnet, an organization that helps people without insurance access affordable medical care, says he’s noticed that people are staying in the program longer because their circumstances aren’t improving. “This has resulted in our waiting list growing from six months to near eighteen.” Gray expects that new federal grant money will enable Portico to help those waiting for its services.
Art Serotoff, program manager at Sabathani Community Center in Minneapolis, is not sure that the economic downturn has had much of an effect on the number of patients coming to the free pediatric clinic at Sabathani. The clinic, which opened in 2007, primarily serves uninsured Latino and African-American families in the south central part of the city. One thing Serotoff has noted is an increasing request by parents for health care for themselves. “Their best resource these days turns out to be the ER,” he says.—Carmen Peota