Grant brings ‘health coach’ to community center in Holley
Site will establish telehealth hub to help people access healthcare
HOLLEY – The homeless and those experiencing poverty and other challenges will soon have access to free health care, due to a grant received by Community Action of Orleans and Genesee County.
Renee Hungerford, director of Community Action, has announced her agency has received a grant from the Finger Lakes Performing Provider System to fund a program she calls “Axis of Care.”
Hungerford has a background in healthcare with a focus on informatics and addressing the social determinants of health. A few months ago she learned FLPPS had some funding available for innovative programs to bring health care to the homeless or those at risk of being homeless.
She wrote a proposal and submitted it. She came up with name “Axis of Care,” likening the meaning of axis (a point around which things gather) to the local agencies gathering together to provide “access” to health care.
Community Action knows first-hand the extent of poverty in Orleans County. Last year Hungerford reported the Eastern Orleans Community Center in Holley served 6,277 meals to nearly 400 people. In addition, hundreds more were helped with free clothing, food pantry services and holiday gifts and baskets.
At the time Hungerford wrote her proposal, Orleans County had the third lowest health ranking in New York state, according to “County Health Rankings.” It ranks in the bottom quartile for both outcomes and health factors.
There is increased risk of premature death, as well as much higher than state average for child and infant mortality. Some of the health behavior challenges are smoking, obesity, lack of physical activity and teen births.
Much of the area is considered a “food swamp,” in that available food is from fast food restaurants or dollar stores. Public transportation is very limited in the county, creating an additional barrier to healthcare and nutrition.
Hungerford reported that according to “Homeless Shelters Directory,” in 2019 there were an estimated 924 homeless people in Orleans County. The pandemic and recent end of the eviction moratorium has certainly increased this number, she said.
Further information obtained by Hungerford states that medical care is estimated to account for only 10 to 20 percent of the modifiable contributors to healthy outcomes for a population. She said Orleans County has only one medical doctor per 13,540 patients.
In response, Hungerford made her proposal to FLPPS to make the Holley Center an access point that brings healthcare to the customers.
FLPPS issued a press release May 26 announcing the grant and explaining Community Action will hire a health coach who will connect and coordinate individuals with services, set and track goals and outcomes, improve health literacy among those in need and coordinate transportation to healthcare facilities as needed. The health coach will be integrated into the existing case management program and collaborate with a peer advocate from GCASA.
A telehealth hub will be established in Community Action’s Eastern Orleans Community Center, where community members experiencing homelessness or being at risk of homelessness can access healthcare using telehealth services. The agency is partnering with Orleans Community Health, Oak Orchard Health and GCASA on telehealth services, and will have a mobile health van from Oak Orchard Health available. The health coach will connect individuals with needed services such as behavioral health treatments and services at the center or at healthcare facilities.
‘Patients need a trusted source to find accurate health information, as well as support in care coordination. This program addresses these challenges by bringing coordinated health and social care to the patient. It is truly a community coming together to make a difference for people who suffer many challenges. I feel blessed with the support we are receiving.’ – Renee Hungerford, Community Action director
A section of the clothing depot at the Community Center will be sectioned off as the telehealth center, where the health coach will work. The health coach will also be able to provide information on Community Action’s other services, such as weatherization, Head Start, utility assistance and day care.
Carol Tegas, executive director of FLPPS, said her agency is proud to partner with organizations in the community who have fostered deep trust with individuals and have the expertise to deliver excellent services in a collaborative model of care.
“This pioneering program aims to address health disparities and will provide vital care to vulnerable individuals in a rural community,” Tegas said.
“Navigating the healthcare system is difficult for everyone and even more so for people who are experiencing life challenges, like poverty and homelessness,” Hungerford said. “Access to care is impeded by a low number of available healthcare providers, coupled with a lack of transportation. Patients need a trusted source to find accurate health information, as well as support in care coordination. This program addresses these challenges by bringing coordinated health and social care to the patient. It is truly a community coming together to make a difference for people who suffer many challenges. I feel blessed with the support we are receiving.”
Sean Ossont, president of Continual Care Solutions, said they are thrilled to be the technology solution partner in the Axis of Care homelessness initiative.
“Being a common digital platform is necessary to have a holistic view of individuals who will be receiving supports and services from a network of community providers,” Ossont said. “Data capture and visibility of outcomes will provide keen insights on best practices and have an impact on the initiative.”
Hungerford said they hope to have the new program up and running as soon as they can hire a health coach, hopefully over the summer.