Healthcare looked a lot different when The Floating Hospital began its mission in the mid-19th century. Back then, before the country’s healthcare model moved into a transactional mode of visits and reimbursements, the essence of healthcare was centered around the notion of relief. Today at The Floating Hospital, that holistic, connect-the-dots kind of quality care is coming full circle.
Based on the national PRAPARE project (Protocol for Responding to and Assessing Patients’ Assets, Risks and Experiences), The Floating Hospital implemented an ambitious Social Determinants of Health (SDoH) project to dig deep into what works and what doesn’t in healthcare for the city’s most at-risk and neediest populations. “We are using the social determinants to tackle these broader issues while in the shelter system,” says Sean Granahan president and general counsel, who says that the project is vital to identifying and overcoming barriers and providing meaningful, relief-driven care that addresses all aspects of a patient’s life living with homelessness. “It’s an absolute domino effect.”
Funded with a grant from the Frances L. and Edwin L. Cummings Memorial Fund, the SDoH project began in 2020, using a customized questionnaire, and in-person in-depth interviews with shelter residents and patients, many of whom said they’d never been asked about their day-to-day lives. SDoH helps assess not just specific healthcare needs, but other issues that create barriers to overall wellness, such as the lack of a place to store and prepare fresh food and other food insecurity issues, or the inability to find dependable, safe housing because a person is unfamiliar with procedures—or how to even figure out where to go to learn what they are. In other words: SDoH offers a way to clearly identify specific issues that patients living with homelessness experience, which are directly affecting their health.
The Covid-19 pandemic put a pause on the project in March but resumed once public-health protocols were in place. The initial Cummings grant was assisted by the Ford Foundation, which already funded a program to better understand life conditions in shelters. The foundation allowed The Floating Hospital to insert its SDoH pilot program into the shelter study sponsored by Ford, allowing the work to continue. The results so far have yielded in-depth insights into a lack of information, direction and social support that could help families living in homeless shelters transcend their circumstances.
“For the poorest populations in the city, healthcare alone just isn’t enough,” says Granahan. “We need to provide them with sensible, practical, helpful advice. It’s the origins of healthcare in New York State. At end of day, that’s what makes all the difference for the poorest among us.”
— Amy Zavatto