A Prevention Model for Homeless Health Care

The Homeless Healthcare Program (HHP) provides outreach to the unsheltered homeless. Four mobile medical teams, comprised of nurse practitioners (medical and psychiatric), community outreach workers, mental/substance abuse outreach workers, in addition to one part-time psychiatrist, are dispatched to areas of the county where the unsheltered homeless live. After assessing each client, teams provide physical and behavioral health care, as well as referral and transportation to medical care, mental health and alcohol and drug services, and dental resources. The unsheltered are offered the opportunity to enroll in existing county programs, be they emergency shelters, alcohol and substance abuse treatment, primary health care, and/or mental health counseling. They are also afforded the opportunity to enroll in the dental and/or denture programs created and funded specifically for this program.

During HHP's first year of operation, NPs treated 488 unduplicated clients. Patients presented with complex and advanced disease pathologies, necessitating the use of priority and acuity ratings. To evaluate the number of emergency department visits avoided, medical conditions were classified using ICD-9 codes. Data from the Virginia Hospital and Healthcare Association (VHHA) were then used to estimate cost-savings for providing preventive and primary health care to the unsheltered homeless. Dental treatment plans were also collected and evaluated using regional private payor data. While Fairfax County's unsheltered homeless population was unlikely to seek acute health care services, significant cost-savings were achieved in stabilizing those patients with dental, cardiac, pneumonia, and mental health conditions.