The Fourth Street Clinic in Salt Lake City, Utah has created an innovative model to respond to the spread of H1N1 influenza. People who are homeless are extremely vulnerable to the flu and other respiratory infections. Jennifer Hyvonen, Co-Director of Development and Communications, speaks with the HRC about the model. They have set up an alternative care site to diagnose, isolate, and treat people who are homeless with H1N1 influenza.
The symptoms of H1N1 influenza include a sore throat, vomiting, diarrhea, a bad cough, a high fever, and shortness of breath. “You don’t need to be a doctor to notice these symptoms,” explains, Jennifer Hyvonen, Co-Director of Development and Communications of the Fourth Street Clinic in Salt Lake City, Utah. “The fact that symptoms are easily recognizable is our biggest line of defense.” The Fourth Street Clinic, a Health Care for the Homeless Clinic, has created an innovative model of emergency readiness to respond to the spread of H1N1 during this flu season.
“Where do people experiencing homelessness go to stay warm in the winter?” asks Jennifer. The answer is public places. “Our patients live in overcrowded and often unsanitary conditions, and many are suffering from two or three chronic illnesses. It shows the need for more affordable housing,” says Jennifer.
The US Centers for Disease Control and Prevention (CDC) projects that 15 to 35 percent of the population may become ill with H1N1 influenza. Spread of the virus could stress the nation’s health care system. To prepare for the worst-case scenario among the homeless population in Salt Lake City, the Fourth Street Clinic has raised $175,000 to establish an alternative care facility to identify, diagnose, isolate, and treat people who are homeless. They are setting up clinics to vaccinate service providers and people who are homeless, as long as they do not have certain medical complications.
The Fourth Street Clinic model could be easily replicated in other cities across the country. The Fourth Street Clinic has partnered with The Road Home, a local shelter that can house up to 60 infected people in their infirmary. If the infirmary fills up, they will have the capacity to care for 80 additional patients in the alternative care facility. Renovations to the facility should be done by the end of November. Jennifer notes the need for careful planning. “You can’t provide medical care based on what you hope won’t happen.”
In preparation for the worst case scenario, The Fourth Street Clinic is training case managers, frontline staff, check-in staff, cooks, and others who work directly with people who are homeless. This training will help them to identify the symptoms of H1N1. “We need to make sure that we recognize people who are sick and communicable so that we can isolate and make sure that they are not housed in the main shelter,” says Jennifer.
The Fourth Street Clinic is providing training for volunteer EMTs and nurses to monitor the care of people who have been diagnosed with H1N1. They have a strong relationship with the local hospital. This will help them to provide chest x-rays, EEGs, and EKGs to diagnose and care for patients. Because the emergency room system may already be strained, patients must be able to access the highest level of care possible at the alternative care facility. The Fourth Street Clinic plans to provide many of the services that patients would receive in an ER, like IVs for dehydration. “Our goal is to isolate, prevent transmission, reduce complications, and reduce the need for further treatment. Eighty percent of our homeless population is not insured. Just because you are homeless and poor does not mean that you qualify for Medicaid in the state of Utah.” explains Jennifer.
The Fourth Street Clinic’s alternative care facility is located next to their main clinic. It will include a separate nursing clinic staffed by volunteer EMTs and a nurse. A medical director and ER response nurse will supervise this clinic. A special communication system will help to quickly transport sick people who arrive at the clinic’s regular office.
The need for the alternative facility grew out of concerns about how the clinic was stretched thin during last year’s flu season. They had to put patients up in motels, which meant that staff had to transport food and medical care. “It depleted our budget, so this year we are looking at how we can provide better care more cost effectively,” offers Jennifer.
A plan to vaccinate 40 percent of the U.S. population, with 150 million H1N1 vaccinations, is the largest mass vaccination undertaking in United States history. Homeless service providers face special challenges in this effort. Their target population has not been designated as high priority for receiving the vaccine, yet shares many characteristics with other vulnerable groups. “College-age students are prioritized because they often live in very close quarters and come into contact with multiple groups of people. These are very similar characteristics found in the homeless population,” explains Jennifer.
“It is essential that we consider the homeless population as communities develop public response and emergency planning systems. How do we serve and treat people who do not have homes and therefore no way to isolate themselves, rest, and recover?” These are the questions that The Fourth Street Clinic is directly addressing. As they open the doors to the alternative care facility, other homeless service agencies may be eager to learn if this model will work in their communities.
To learn more about the Fourth Street Clinic’s model, please contact jenn@fourthstreetclinic.org.