Street nursing program gets lifeline: Harmony Health set to take over unhoused effort previously under Adventist

Apr. 25—Almost two weeks after the abrupt ending of the Street Nursing Program at Adventist Health/Rideout Hospital in Marysville, Harmony Health has stepped up to continue much of the work that the hospital had been doing since 2019 to help the area's homeless population.

Both Rachel Farrell, CEO of Harmony Health, and Chris Champlin, president of Adventist Health/Rideout, confirmed the transition with the Appeal on Thursday.

The team that made up the original Street Nursing Program included a nurse, social worker, dietician and housing navigator. Farrell said she hired three of the four this week to continue the work they did for the hospital at Harmony Health — the housing navigator was not hired.

The three will not be able to fully do the work they previously did until they are credentialed, Farrell said.

"Everybody who works in a medical clinic has to be credentialed. You have to prove they are who they say they are," Farrell said.

If the credential process is able to be started as soon as this week or over the weekend, Farrell said they could be back on the street and working as early as Monday.

That timeframe is important because several homeless individuals who were previously helped by members of the Street Nursing Program have, for the most part, been unable to communicate with them. After their positions were eliminated by Adventist Health/Rideout on April 12, the team's cell phones were turned in, thus ending the direct communication they had via those devices.

Champlin on Thursday told the Appeal that the hospital has been monitoring those phones since April 12 to make sure gaps in coverage or communication were not taking place.

The decision by Adventist Health/Rideout to end the program and transition it to other providers was largely due to its cost and the fact that the services it was intended to provide were redundant, according to Champlin. Since announcing the end of the program, Champlin has stressed that it would be a transition to other providers called FQHCs (Federally Qualified Health Centers). Locally, those providers include Ampla Health, Peach Tree Health, and Harmony Health.

Under Adventist Health/Rideout, the hospital was not reimbursed for many of the services provided by the Street Nursing Program. While it did receive some grant money, that funding was not enough to cover the entire operations of the team.

Now that the program has been transitioned to the FQHCs, some reimbursements are possible through Partnership HealthPlan of California and its contract with Medi-Cal.

"Partnership will pay the FQHCs $400 per member per month ... to take care of them (the homeless)," Champlin said.

Because Adventist Health/Rideout is a hospital, it was not eligible for those same reimbursements, Champlin said.

With the ability to utilize Partnership HealthPlan of California, Champlin said he would like to see the FQHCs include a member of Partnership with any street nursing team. He said doing so could streamline the medical care process by allowing a client to say "yes, I want Harmony Health to be my provider."

Champlin said there was an advantage to having a Partnership member included in a street nursing team.

"The beauty of having a Partnership person there is the Partnership person knows that that person is already assigned to somebody else," Champlin said. "So, they might be a Peach Tree member, they might be an Ampla member or they might just be unassigned. In which case we want to make sure they get in to make their choice. What we don't want to have happen is they start competing ... then it's just chaotic."

Prior to Harmony Health's decision to bring back the majority of the street nursing team, the FQHCs mostly provided mobile health clinics to meet the needs of the unhoused and those who are typically underserved. According to Champlin, that was the original intent of the Street Nursing Program. Over time, members of the team expanded the program to better serve their clients.

Aundrea Caracciola, who was the lone nurse in the Adventist program and was rehired by Harmony Health, previously told the Appeal that what they were doing was not offered in full by other providers.

"Our interest is to continue street medicine because what street medicine means is we go to the people," Caracciola previously said. "We're not parking in a van somewhere and asking people from the river bottoms to come to us because that's a barrier in care."

Not only were members of the Street Nursing Program providing basic care, but they also helped guide individuals through different processes involved with receiving proper care.

"It's so much more than just street medicine ... also attending some of these appointments and advocating for specialty services that they would not be able to advocate for themselves, or getting there to those appointments," Alexis Rickards, a social worker who was in the program and also hired by Harmony Health, previously said. "It's even more than just what we do on the street, but what we're bringing off of the street into medical to keep them out of the hospital setting."

Keeping patients out of the hospital, and most notably out of the emergency room, was an important aspect of the Street Nursing Program. According to documentation from Adventist Health/Rideout, the program was "successfully able to increase the number of individuals seen by tele-medicine out in the field and in turn reduce the number of individuals sent to the emergency room for treatment."

The documentation stated, "In 2021, 78 individuals of the 2,561 were sent to the emergency department for additional care and 314 were able to be seen via tele-health. In 2022, only 55 individuals of the 3,574 were sent to the emergency department for additional care and 342 were able to be seen by tele-medicine. This shows an overall reduction in the number of individuals sent to the ER and an increase of individuals seen by tele-medicine."

To further lessen the burden placed on the hospital, efforts such as Project Hope are currently underway to serve patients that otherwise have no other place to go for mental health or other behavioral health treatments. Champlin said Thursday that should Project Hope be fully realized, it will significantly reduce the number of patients both staying at the hospital long term and those taken to the emergency department — both of which are major financial strains on Adventist Health/Rideout.

An initial phase of Project Hope is already underway, but funding for the major part of the plan hasn't been acquired yet.

On Thursday, Farrell spoke about the importance of the Street Nursing Program, a program she said she had wanted Harmony Health to do for a long time.

"I wanted to do it from the beginning. This is what we do. We work with the most vulnerable populations. I always wanted to do it, but because the hospital was doing it, I felt like I was duplicating services," Farrell said. "... We're just gonna take the patients on and we're gonna take care of them. ... It's vital. People need to build trust with a provider who they don't feel is gonna turn them into CPS, turn them into the cops, that they're not gonna get in trouble, that they're gonna get the help that they need. And having those relationships and that trust is what helps them come in for the health care that they need."