The Boston Health Care for the Homeless Program (BHCHP)

BHCHP was one of 19 projects funded nationwide by the Robert Wood Johnson Foundation and the Pew Charitable Trust from 1985-1988. The Commonwealth of Massachusetts provided matching funds. The mission has remained simple and direct: to provide or assure access to the highest quality health care for homeless individuals and families in Boston. The project was conceived by a broad-based coalition as a catalyst within the mainstream, working to integrate medical care in shelters and on the streets with the care provided by Boston’s renowned academic teaching hospitals and neighborhood health centers. The coalition also charged the fledgling project to develop and implement a medical respite program to care for homeless persons too ill or injured to withstand the rigors of survival on the streets but not sick enough to require acute care hospitalization.

The BHCHP service delivery model utilizes three hospital-based clinics (Boston Medical Center, Massachusetts General Hospital, and the Lemuel Shattuck Hospital). Multidisciplinary teams, comprised of doctors, nurse practitioners, physician assistants, nurses, social workers, and outreach workers, venture out to provide direct care services at over 70 outreach and community sites throughout metropolitan Boston. These sites include adult and family shelters, soup kitchens and day centers, shelters for victims of domestic violence, motels and hotels, detoxification units and transitional programs. One team provides care for the backstretch workers who live in the barns of two local thoroughbred racetracks, while another team joins the day and night outreach workers who care for those sleeping rough under bridges, in back alleys, and on Boston’s streets. Respite care, a word adopted by the homeless advocacy communities in Boston and Washington, DC, has come to mean acute, subacute, pre- and post-surgical, recuperative, rehabilitative, palliative and end-of-life care for homeless persons who would otherwise require costly acute care hospitalization. Respite care has emerged as a critical component in the continuum of services necessary for providing quality health care for homeless populations. BHCHP’s original respite program (the first of its kind) began in September of 1985 with 25 beds nestled in a corner of the Shattuck Shelter, an arrangement which soon proved less than ideal given the increased acuity of illness as hospital lengths of stay rapidly decreased. In 1993 BHCHP opened the Barbara McInnis House, a free-standing 92-bed respite care facility. Now over 35 cities across the USA and Canada are developing respite programs, including those participating in a 10-city respite care demonstration program funded by the Bureau of Primary Health Care.

Comprehensive oral health care is provided in a state-of-the-art dental clinic at the South End Community Health Center as well as at two dental suites at the McInnis House. Mental health and psychiatric services are fully integrated into the primary care sites throughout the service delivery model. The Family Team works directly with several community health centers as well as the pediatric and family medicine clinics at Boston Medical Center to assure continuity and accessibility of care for families living in shelters and distant motels.

Coordination of care has been vastly improved since the implementation of an electronic medical record in 1996. All clinicians at any of the three hospital and 70 outreach sites enter data directly into each patient’s chart, which is easily accessible over local area networks or traditional phone lines.

BHCHP serves more than 8000 unduplicated homeless persons each year. Our original staff of eight has now grown to over 250 individuals, including 12 MDs, 3 dentists, 19 NP/PAs, and over 30 RNs.

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