BHCHP’s case managers who work in the BMC clinic, including Carlos Echevarria (center, in plaid).
By Delia Harrington
Carlos Echevarria, a case manager at BHCHP, was standing in the kitchen of a recently housed patient’s studio apartment, trying to make a defective can opener work. His patient, “John” had been proudly showing off the groceries he had in his cabinets and how clean he was keeping his kitchen when he remembered the tuna fish he hadn’t been able to eat, because his new can opener was giving him trouble. Eventually Carlos got the device to work, and after the third can of tuna, Carlos laughed, “I can’t wait to write the notes on this.”
When people think of Boston Health Care for the Homeless Program, they typically consider our medical or behavioral health work on the street or in over 40 shelter or hospital locations in Boston. Case management is one of the vital parts of our work that focuses on supporting the important social circumstances of our patients, which can be critical to their overall good health.
Carlos is visiting “John” (not his real name) in his new home as part of the outreach portion of his case manager role. Carlos had noted that John was having difficulty meeting deadlines and appointments so he brought along a calendar and mounted it on the wall. Whenever they discuss commitments, Carlos or John writes them on the calendar. They planned a supermarket trip, making a list and scheduling it on the calendar on the day John’s food stamps became available. John is appreciative, saying that before he met Carlos, he was spending half his budget for food at the convenience store, where prices have a significant markup.
It’s these small touches that can make all the difference for someone to successfully transition from a life on the street to an independent life in their own housing, sometimes for the first time in decades.
“We see our patients in their new apartments, in the hospitals, in our clinics, and on the streets. Wherever they are, we’re there,” says Carlos. We work with patients with a range of complex medical issues, from congestive heart failure to schizophrenia. This can often involve coordinating care with our partner hospitals to ensure that the providers are on the same page and our patients are able to navigate these interconnected systems during what is an overwhelming time.
Accessibility for our patients to excellent support services is key to their wellbeing, sometimes an essential piece of their ability to participate in medical and behavioral health services.
Each case manager works with 25 patients, as part of BHCHP’s patient-centered care teams. “When we come in each morning, we never know what to expect. It could be immigration-related issues, it could be housing, it could be someone who needs clothing,” Carlos shared. But regardless of the need, the case managers of BHCHP work compassionately and diligently to meet it.
As Diana Aycinena, our Director of Case Management, says, “case managers do really brilliant work in really hard circumstances, largely outside of the spotlight.”
“Every patient is different.” As Carlos says, “it’s all dependent on what the individual patient needs.” What works with one person may upset another, so the best case managers are patient, mindful, empathic, intuitive, and extremely good listeners, like Carlos. Luckily, he and his colleagues are also very resourceful, keeping up with the ever-changing nature of the complex web of services our patients need to access, from housing opportunities to immigration possibilities.
And Carlos is just one of the more than 40 case managers throughout the program. They work in SPOT (Supportive Place for Observation and Treatment), OBOT (Office Based Opioid Treatment), medical respite program, street outreach, and in other clinical settings. Essentially, anywhere a patient would need assistance, from navigating complex medical systems to helping with day-to-day tasks, case management is there. The time they spend with our patients maximizes our clinicians’ time with the patient to focus on medical and behavioral health issues. Case managers’ invaluable services recognize the impact that issues like shelter, employment, immigration status, and the ability to buy groceries or keep medical appointments can have on one’s overall health, particularly for those living on the street or in shelter.
Which brings us back to the cans of tuna. Carlos’s patient was right: the can opener was frustrating. For someone like John who has so many challenges to deal with each day, a simple setback like paying for a nonfunctional can opener and then not being able to eat some of your own groceries can become a big deal, particularly if there’s not much room to spare in the budget, and nothing else to eat in the cabinet. But tuna is a better lunch than convenience store food, so they decided that Carlos should open enough cans for the next few days until they could got to the store to get a new one. John put the tuna in the refrigerator and his dishes in the sink, making jokes to Carlos the whole time. This afternoon came after weeks of building trust, and BHCHP’s patients like John can count on Carlos and his fellow case managers to continue to guide them on their way.
Delia Harrington leads Communications for Boston Health Care for the Homeless Program.