“I went from sleeping on sidewalks to not smoking, not drinking, not using,” said Front Street Clinic patient Hazel LeCount. “I’m a person of standing in the community because of Janna and Mary and what they’ve done for me.”
LeCount is one of about 300 clients served by Front Street Clinic, which is going through a major transition with its upcoming separation from SouthEast Regional Health Consortium on May 1.
In August 2013, SEARHC announced it would be closing the clinic, which serves Juneau’s homeless population, by Oct. 1. The decision would save the organization an estimated $300,000 annually.
“To have that extra $300,000 to reallocate to our other rural clinics can make the difference between having someone on-call or not having someone on-call throughout our region,” SEARHC COO Dan Neumeister said in an August 2013 interview. “It’s a big deal.”
But after the announcement of the planned closure, more than $100,000 was raised to keep the clinic open for an additional six months, allowing community members like Glory Hole executive director Mariya Lovishchuk the time to figure out the next steps.
Now, with barely a month before Front Street Clinic’s ties with SEARHC are severed, the board for the soon-to-be Front Street Health Center have it all figured out — though they are still seeking donations to keep the clinic from accruing a deficit in the coming months.
“We’re in a transitional period,” Lovishchuk said. “A hard and stressful period, waiting for grant funds to come through.”
Lovishchuk spearheaded the effort to save the clinic from closing its doors and brought together a surprising group of allies to form the board for the Front Street Health Center.
“We have agencies on the board rather than individuals,” Lovishchuk said. “Agencies as board members bring in resources.”
Represented on the board along with Lovishchuk are: Front Street Clinic nurse practitioner Janna Brewster, behavioral health clinician Mary Fitzgerald and dentist Ed Linsell; Jeannette Lacey Dunn of Bartlett Regional Hospital; Sarah Hargrave of the Juneau Public Health Center and Kelly Pajinag with Catholic Community Service.
Neumeister said in a Saturday interview it was a very positive transition working with the Homeless Coalition and commended them on organizing into an independent clinic in such short time and “really without any complications or stoppage of care for this pretty vulnerable group.”
Cheaper than an ER visit
Without a clinic serving Juneau’s most vulnerable population, the only other option for Front Street patients is Bartlett’s Emergency Room. Visits to the emergency room for conditions that could be treated at a non-emergency facility put strain on the ER and aren’t cost-effective, according to Bartlett’s Lacey Dunn.
She provided a rundown of costs for ER visits at BRH, with lower fees around $186 for being seen by a nurse and an additional $103 if seen by a doctor. That doesn’t include costs for procedures, supplies or medications. At the highest level, costs are easily in the thousands without accounting for those additional variable costs. An ambulance ride to the hospital can cost about $600 more.
Lacey Dunn called ER visits for all health care needs inappropriate and said there are missing components. If an ER doctor hands a homeless patient a prescription, the patient would be unlikely to be able to fill that prescription.
And ER visits only treat the most immediate issues.
LeCount came to Juneau in April 2013, couch surfing with her niece after coming up from Reno, where she was also without a home.
‘I didn’t know which way to turn’
“When I got here I was extremely sick, bronchitis and I don’t know what else,” she recalled. “I was so sick, just to walk the three blocks from my niece’s house to this clinic, I couldn’t breathe. The first time I saw Janna, she put me on a nebulizer and gave me several inhalers and antibiotics.”
That was the start, but LeCount visits the clinic every week or two, she said — more if she finds herself in a place where she needs additional support. She’s received not only medical care, but also mental health and dental care at Front Street Clinic, and she said she has Front Street Clinic to thank for the progress she has made.
LeCount currently lives in transitional housing at St. Vincent de Paul and keeps busy providing care to children also staying there. She also helps out at the Polaris House.
“I’m able to give back,” LeCount said. “I’ll do anything I can to help anybody, because I had been in that spot, I didn’t know which way to turn or who to turn to.”
LeCount attributes her health and improved state to the integrated care provided at Front Street Clinic, the ability to treat not just acute issues, but deeper physical and mental ones.
“I have PTSD, severe anxiety and depression. (Front Street Clinic) is helping me to deal with those issues,” LeCount said. “We’re dealing with them instead of just stuffing them and pretending they don’t exist. Without (clinician Mary Fitzgerald), I would still be very angry. ... Now I’m learning to cope instead of — I don’t have to self-medicate anymore. I did before. I self-medicated with anything, everything — I don’t have to do that anymore.”
LeCount said if she was having a bad time, she could show up at the clinic and Brewster or Fitzgerald would find time for her.
“They’ve been a Godsend, they both have, I don’t know what other way to put it,” she said.
Front Street Clinic’s Brewster said it’s nice to have a mental health provider available when people are in crisis, or to have a dentist available. The philosophy at the Front Street Clinic is that treating the root of the problems will help get clients to a place where they can better take care of themselves.
‘The sickest of sick’
The clinic ceased to provide dental service in October, but Linsell will resume dental care starting in May. Meanwhile, SEARHC has been taking dental emergencies.
“We replace missing teeth, we replace a smile,” Linsell said. “They start feeling better about themselves. With increased mental and medical health, they’re ready to step out into the sunshine.”
Fitzgerald said she’s seen it as well, people come in and get dental work done and have new confidence.
“The integrated health model is a very successful model,” she said. “And we work well together as a team.”
It’s a small team for the number of clients served and the number of patient encounters.
The three providers, Brewster, Fitzgerald and Linsell, plus one case manager, two nurses, one administrative staff member, a dental assistant and hygienist served about 300 clients during 2,300 visits in 2013, Brewster said.
“We see the sickest of sick,” she said. “Not ICU, but diabetics, hypertensives, seizures, alcohol and drugs, really serious mental health issues and it can sometimes take weeks to get teeth restored.”
Starting small, then expanding
While the staff and community were devastated when the news hit that SEARHC would be closing down Front Street Clinic, the board that formed to keep the clinic open is optimistic about the independent clinic they’ll be unveiling.
“I commend the staff, who have been very dedicated and have been really great and have had a great attitude,” Neumeister said, adding that most, if not all, will stay with the clinic.
The staff and integrated health philosophy will continue to serve Juneau’s homeless population, as well as expand services to other medically underserved populations, starting first with those who fall in the gap between Medicaid and Affordable Care Act coverage.
The board is almost certain they’ll receive a Health Resources and Services Administration grant that will fund the treatment of the homeless population, and they will welcome low-income individuals who can pay on a sliding scale.
“The clinic is to be run really efficiently, with little duplication of services,” the Glory Hole’s Lovishchuk said, adding they will save money because they don’t need their own diagnostics. The clinic is budgeted to run on a mere $40,000 a month.
When the transition is complete on May 1 and the clinic opens its doors as Front Street Health Clinic, they plan to start small — continuing service to current clients and adding others with the most need — but with high hopes to provide a comprehensive medical home for people who wouldn’t have it, Bartlett’s Hargrave said.
“We could eventually open up to people who make three to four times that (poverty level income),” Linsell said.
“The services offered by this clinic I would recommend to anyone,” LeCount said. “They really will do anything in their power to help you get on your feet — give you a pair of socks or a hug, you know.”
For LeCount, the Front Street Clinic has given her faith in a generous community, and for the Front Street Clinic, the outpouring of support from residents in the way of monetary donations has done the same.
Funds are still needed to allow the clinic to continue providing the services that clients like LeCount rely on. Donations may be made through the Juneau Community Foundation for the Front Street Clinic. A fundraiser also will be held at 5 p.m. on May 16 at the Rockwell Ballroom, featuring a cocktail hour, dinner, dessert auction and a film to fit the theme.
“It’s a great illustration of community coming together to meet an important need,” Lacey Dunn said. “The top priority is keeping services available. It was a true call to help to the community and the community did answer and continues to answer. It’s been a beautiful experience.”
Editor's note: Corrected to reflect Sarah Hargrave's position with the Juneau Public Health Center, part of the Alaska Division of Public Health.