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Home Visitation Program a "Game Changer" for Schenectady's Medically Underserved Patients

Monday, Aug. 24, 2020 --  Routine medical appointments for medically underserved patients in Schenectady County have become easier and safer during the ongoing pandemic, thanks to an innovative home visitation program offered by Hometown Health Centers (HHC), a not-for-profit, federally qualified health center in Schenectady County.


The program, which launched in March, is open to chronically ill patients over 60 and those who can’t leave their homes or who are wheelchair bound. These patients also cannot have Internet access.

Like many Capital Region healthcare providers, HHC began offering telemedicine visits when coronavirus cases began spiking across New York state. However, since a large number of the 65,000 patients HHC sees annually are highly vulnerable, medical staff soon realized their most disadvantaged patients were being left untreated because they lacked either the appropriate computer hardware or the knowledge about how to use it.

“Since we couldn’t get them to reach us via our telemedicine platform, we knew we had to find a way to bring teleconferencing equipment to them so they could connect remotely with our on-site medical providers,” said HHC Chief Medical Officer Cristine Espinosa. “Patients are loving the program. We’ve seen more than 300 patients to date!”

“Although visiting nurses and some public health programs have a rich history of taking care of patients in their homes, house calls are extremely uncommon for busy primary care practices like ours,” added Hometown Health Centers CEO Joe Gambino. “This clinical option has been a game changer, especially for our frail and vulnerable patients.”

HHC’s home visitation program is run by a team of registered nurses, licensed practical nurses, medical assistants and case managers. The team schedules appointments and conducts patient assessment phone calls prior to each home visit to ensure patients aren’t exhibiting COVID-19 symptoms that could be passed along to members of the HHC medical team or immediate family members. Once the appointment is set up, two team members travel to the patient’s house wearing full personal protective equipment. Once inside, they take the patient’s blood pressure, temperature, and oxygen levels and, if necessary, draw blood.

“They also conduct a social determinants of health screening to establish if anything is taking place in the person’s life that might affect their well-being,” explained Dr. Espinosa. “They look for food insecurity, whether the person has access to reliable transportation, and if they need help around the home. All of the person’s needs are assessed, so that we can refer them to outside organizations that can better meet those needs.”

Once all the data is collected, the patient is beamed into the HHC physician’s office via a laptop or iPad via a MiFi hotspot connection. The HHC physician has access to all of the data and is able to conduct a thorough interview.

“Sometimes the doctor may ask the on-site team to adjust the video camera so that they can view a specific area of the body where the patient may have a concern,” she noted. “The physician may also request permission from the patient for the team to give them a tour of the house, where they can detect everything from tripping hazards to poorly installed grab bars in a shower, all of which can change a person’s medical or safety plan.”

Dr. Espinosa said that HHC, which offers comprehensive primary medical, dental, behavioral health, and vision services, as well as on-site lab and pharmacy from its Schenectady office, plans to expand the home visitation program to Montgomery County’s medically underserved population starting this fall. HHC maintains a second office at 67 Division Street in Amsterdam.

Since vaccination rates for non-influenza childhood vaccines have dropped drastically during the pandemic across the United States, Dr. Espinosa is also making plans to expand the program to offer routine vaccinations and see children in the home.

“Over the past five months, this program has led to improved patient outcomes and enhanced patient satisfaction,” said Gambino. “It’s keeping our most vulnerable patients safe from contracting the virus, providing them with the care they need to avoid costly ER visits, and helping them maintain a continuity of care with their primary care providers. Additionally, it’s addressing different issues in the home that our medical providers may not be able to fully comprehend without a video conference. We plan to continue our home visitation program long after the pandemic is over.”

For more information and to schedule a home visit, please call HHC at (518) 370-1441.



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