San Francisco VA Health Care System
How Our HPACT Helps Homeless Vets in San Francisco
On any given night in San Francisco, there are 3,401 people sleeping in the streets. There are 6,436 homeless people in our city in the parks, alleys, in shelters or transitional housing, per the latest Human Services Agency survey.
Chronic homelessness affects Veterans more than the average population, and homeless Veterans have a high rate of serious medical, mental health and substance use issues. Although the percentage of homeless military Veterans has decreased from 17 percent to 11 percent since 2011, there is still much work to do.
One of our community based outpatient clinics, the San Francisco VA Downtown Clinic, has implemented an effective program to reach out to homeless Veterans in our community.
“We created a Homeless Patient Aligned Care Team (HPACT), with the idea to transform primary care to best meet the needs of homeless Veterans and take care of them,” says Amy Noack, MD, Medical Director, San Francisco VA Downtown Clinic.
“Homeless Veterans have different needs than the average VA patient: They lead very chaotic lives; it’s difficult to make appointments, there are trust issues, they have a more difficult time aligning with providers, and they sometimes have to have shorter visits & meet with us more frequently before they start opening up,” says Noack. “They have many competing priorities, so getting through all the healthcare maintenance in one appointment is just not going to happen.”
The HPACT members—a primary care provider, two social workers, a nurse and a psychiatrist—provide outreach to homeless Veterans who don’t come in at all, who’ve never enrolled at the VA, or who came in once 10 years ago and never returned, and to those who use Emergency Departments or Urgent Care, but won’t come for primary care. “When their focus is on basic survival, preventive health care is very low on the list of priorities,” explains Noack.
The HPACT nurse and the social worker go out into the community and build alliances by talking to homeless Veterans, and try to get them to come in. They’ll bring food, clothing, supplies, offer them rides to the clinic and other places Veterans need to go.
Noack explains: “Our whole clinic is oriented to homeless primary care. We have drop-in appointments every day. We have nurses available for walk-ins all day long. We have laundry facilities, a free computer lab, showers, hygiene products, a clothing locker room, and lockers to store personal items in. We have a primary care clinic here co-located with all the social services. All the homeless services are right here next to us. So someone can come in who just showed up in town, homeless, walk in the door and get seen by a primary care provider and social services, get a shower, get his clothes washed, hopefully secure some housing, and then we have mental health care as well. We feel it is really important to offer ‘one-stop shopping’, same-day appointments, and to be seen for all the services they need on the same day.”
The clinic also serves coffee and pizza daily to encourage Veterans to feel comfortable, important, and cared for. “We have Veterans who come in every morning, have a cup of coffee, and then go to their sobriety and support group,” says Noack. “If all they want to do is get a cup of coffee, that’s fine. So the next time they visit, hopefully they might talk with a social worker. And the next time, they might want to see a doctor. We’re not trying to force people into a mold where they have to do this or that. We try to figure out what we can help them with.”
Since HPACT started at the VA Downtown Clinic in January 2012, Emergency Department use by homeless Veterans has dropped 54.3 percent, and hospitalizations are down 60 percent. “I hope our services and outreach efforts will improve their quality of life while they’re here, and we all feel quite passionate about that,” says Noack. “We hope our services will be a catalyst for a better quality of life, and hopefully our Veterans will also live longer. A lot of our homeless Veterans are living very difficult lives, daily going through trauma, and we try to alleviate some of that.”
The VA Downtown Clinic is located at 401 3rd St. and Harrison; open Monday – Friday, 8 a.m. – 4:30 p.m. The clinic may be reached by calling 415-281-5100.