A day in the life at FHC-Phoenix homeless clinic

By Sally McMahon

Teresa Casey

Meet Teresa Casey, APRN

  • Received Associate in Nursing from EKU; Bachelor’s in Nursing from UofL; Masters of Adult Nursing (Clinical Specialist) from UK; and a post-graduate certificate as a Family Practice Nurse Practitioner.
  • Began nursing at Louisville General Hospital in 1978.
  • Prior to FHC, practiced in rural areas and managed HOPE clinic, a chronic disease management and volunteer clinic for uninsured. Worked with individuals in an addiction recovery program as well as general family practice and urgent care.
  • Retired from the Kentucky Army National Guard, serving in Desert Storm with the 475th MASH and a Faith Community Nurse educator.
  • Enjoys swimming at the YMCA, crafting scrap books, working with copper foil stained glass and quilting. Also loves traveling and going to state and local parks (or the Louisville Zoo), walking trails and being in nature.

Since 1988, Family Health Centers (FHC) has operated a Health Care for the Homeless Clinic in the Louisville Metro region. Centrally located near downtown Louisville and close to the city’s homeless shelters, FHC- Phoenix services more than 4,500 homeless adults and children each year.

We recently talked with Teresa (Terry) Casey, APRN, who has worked at FHC-Phoenix for three years, about what her days are like caring for the most vulnerable in our society. Below are the highlights.

Medical News: What is a typical day like for you at FHC-Phoenix?

Teresa Casey: The door opens at 7:15 to begin scheduling and registering patients. Many of the patients are overflow (walk-ins) so they come early to try to obtain an appointment when someone doesn’t show or there is an empty place in someone’s schedule, which is rare.

I practice primarily in outreach, which means I go to various outside sites such as the Jefferson Street Baptist Community at Liberty where I can engage people who are there for breakfast. I hold clinic and provide medical care sending people to Phoenix for labs, treatments and to get medicine. I work with an outreach worker who can assist with social service needs.

No one is pre-scheduled. It is all on a first come, first served basis. On a typical day I will see six to eight people in about two hours (maximum is about 11- 12 people), but I will see as many people as possible before the doors close and I move to another site. The outreach sites are prearranged so that people know where and when they can access care.

I also visit individuals who are in emergency medical respite beds at a local shelter. These are people who have been in the hospital or are very sick and need to be off the street and not in a general shelter environment to heal. They must be able to take care of themselves as there is not full-time medical care provided.

On a typical day FHC-Phoenix will process 100 or more individuals in various capacities. We provide primary care, mental healthcare, dental, lab, outreach and social services for housing and other needs, obtaining health insurance and screening TB tests (which are necessary for people to stay in shelters or to go into day programs).

MN: What are a few of the challenges you face while in the exam room with patients?

TC: Working with homeless individuals presents various challenges. Obviously the greatest of these is the social and environmental factors that precipitate and accompany medical problems, whether chronic or acute. The other major issue is mental health problems and addictions that co-exist or are exacerbated by homelessness, inconsistency in care and access to care.

Our population is generally middle-age or older so many people have multiple chronic and uncontrolled health conditions which can be difficult to manage medically. It is very common for medications to be lost or stolen. It is also common for specialty appointments or follow-up appointments to be missed.

Homelessness causes people to live in the moment, which is often chaotic. Their focus is finding shelter, food, missing papers (i.e. ID, social security, birth certificate) so they can work or get assistance. Therefore, being consistent with medical care, follow up and preventive care for many is not a priority.

As a medical care provider, I try to address as many problems and accomplish as much as I can in the short time allotted for a visit because routine follow-up is not always a reality.  I try to engage people where they are, not only meeting the basic needs but educating them regarding their health problems and preventive care needs and connecting them with needed services.

Helping a person manage diabetes is also understanding where they live, their mental health problems, their previous experiences and why they may or may not be able to do what is needed for self-care. I try to empower them in some way to take control of their health.

Another challenge is scheduling. It is not uncommon for people to leave or not show for appointments. They forget, get temporary work, end up too far out of the area to get back for medical care or the need to tend to other things outweighs their need to attend to their health. What is anticipated when the day starts is not generally how one finishes.

MN: How can the healthcare community better address these challenges?

TC: It would be great if we could have more Phoenix medical sites – either physical or outreach. There are people who have moved to other areas of the city due to the disbanding of camps and are not accessing medical care due to the travel distance and lack of transportation or bus fare.

People who are in poverty or homeless can go to other medical practices but there is not a good understanding of the reality of people’s existence and the challenges are difficult to address without a large social service network.

Patients are expected to follow general societal norms and expectations for self-care in the healthcare world and they are not able to do this. Many people need specific assistance in obtaining medications, getting to specialty care and generally managing their health in a homeless environment.

Mental health issues, trauma informed care and environmental impacts are not part of general healthcare education or the norm for general medical practices. Most cannot address the unique needs of homeless persons, so the obvious solution is to expand the medical practices that specialize in the needs of homeless persons.

The Family Health Centers eight clinics are adept at caring for a diverse population with many social and environmental needs. Our medical staff is compassionate and recognizes the unique challenges people present and works to ensure every person has their health needs met.

At FHC-Phoenix we have grants and specialized services that allow us to provide care for a population with very specific needs–and there is more need than availability at times.

MN: Are you using resources such as PRAPARE or United Community?

TC: At FHC-Phoenix we use a different social assessments tool for the homeless, called the Common Assessment/HMIS assessments and it is incorporated in the electronic health record. I am aware of United Community through the United Way, and I know that FHC is collaborating with them to accomplish mutual goals of connecting people to local resources.

From my perspective, much of the community work is accomplished with our partners such as the Coalition for the Homeless and other venues that meet regularly for the purpose of sharing and managing information and resources specific to the homeless.

MN: How does FHC-Phoenix’s Rx Housing Program fit in with your work?

TC: At FHC-Phoenix, we believe that housing is healthcare for our patients. People cannot take care of themselves if they do not have a secure environment. When you spend your day trying to stay warm or cool, get a meal, be safe (a very big concern), look for a job or recover from a health crisis, you cannot be productive.

It is difficult to get a job if you don’t have a place to get clean, keep clothes, don’t have transportation or a phone. Having a place that you can feel safe, keep clean clothes, get a warm shower and sleep without being hyper-vigilant is the first step to helping people become productive and healthier in all ways.

I hear from so many individuals “when I get housed” how they will be able to manage their lives in a different way. People who are homeless often have income, jobs, a productive past, until an illness or lack of ability to afford housing has caused their situation.

The Rx Housing program combines housing vouchers with support services such as case management, substance and mental health treatment services, to help keep people in their homes.

However, in order to address the social and medical problems of homelessness, the shortage of affordable housing and prioritize housing as the first step in solving the crisis needs to be addressed.  

MN: What are you most proud of in your work?

TC: I am proud that I work for a healthcare community, FHC, that truly understands the challenges faced by our patients and those of us providing care. The administration is supportive and empathetic because they were clinicians first, have practiced in our care delivery environment and because they also are very committed to FHC and the larger community we serve.

I am proud that I have a full spectrum team of individuals–medical, pharmacy, dental, outreach, housing, peer support—who support me in my practice and provide a safety net for our patients. I could not accomplish my work without each person on the team who contributes their skill and compassion. I think collectively we all gain satisfaction in making a difference in someone’s well-being, be it physically, mentally or environmentally.