In 2015, a nonprofit that helps house hundreds of New Yorkers who have a mental illness or are homeless began hiring nurses to handle non-emergency and preventative care. As a result, avoidable visits to hospital emergency rooms have fallen by half, the organization says.
Housing experts say Urban Pathways’ investment in on-site health care is a novel approach they hope can become a model for other programs that provide housing and services to residents who often lack a primary care doctor and are driven to rely on hospital emergency rooms for basic care and treatment, including for things like stomach aches and nausea.
ER visits are generally much more costly than primary care and can strain emergency services. But even Urban Pathways says changing habits can take time.
The organization decided to hire nurses at a supportive housing site in the Bronx after staff noticed a high number of ER visits and 911 calls. The grant-funded initiative has now expanded to eight locations across the city and features wellness programs serving 400 residents who were homeless or discharged from state psychiatric hospitals. Each location has a nurse who offers referrals to doctors through Medicaid and helps coordinate nutrition and exercise workshops.
The state funds some supportive housing in the city and says providers can use money for health programs. But having a dedicated nurse on site is rare, according to Urban Pathways officials, who say it’s an investment that can take time to pay off.
While the group's program has slashed ER visits, other successes are slower to come by: getting residents to routinely take their medication; go to their annual doctor's visits; or eat healthily so they can address illnesses like diabetes or Crohn’s disease.
Nurse Althea Lewis-Sewell is part of a program run by Urban Pathways that provides on-site health care to people in some supportive housing sites.
“When I first started, they'd call 911 for everything, it didn't matter — 911 was their doctor,” said Sandra Perkins Lawrence, a nurse who works at a supportive housing site in the Bronx. “Just because you move somebody off the street doesn't mean that they're good. You have to give them the tools, so you have to let them know what's available to them.”
Mayor Eric Adams is trying to move more homeless New Yorkers into permanent housing programs, with a record number of people living in homeless shelters — a trend city officials have attributed to the arrival of new migrants. Adams has also prioritized getting people with mental illnesses off the streets, including by involuntarily committing those who refuse treatment and disassembling homeless encampments across the city.
Health experts at Urban Pathways say improving people’s health can help them stay off the streets and develop better habits to live on their own successfully.
“We're really focused on a holistic vision of wellness with our residents, so we try to help them with financial literacy, communication skills, oral health, nutrition, exercise, and help them to understand how aspects of their lifestyle might be impacting their health,” said Annie Hanford, manager of the Total Wellness Program at Urban Pathways.
Between 2022 and 2023, avoidable emergency room visits for Urban Pathways sites with the health program dropped from 102 to 50. And now 93% of residents are receiving primary care, compared to 72% at sites without the program, according to the nonprofit.
Urban Pathways offers exercise opportunities like yoga and walking groups, provides rides so that residents can get to their doctor’s appointments and organizes health education workshops about high blood pressure and diabetes. Workers also accompany residents to grocery stores so they can learn to shop and eat more healthily.
“Instead of just responding to emergent care, we really want people to engage in prevention: Getting annual physicals, getting vaccines, getting cancer screenings,” Hanford said.
Willie Woods, 41, has lived in supportive housing in Astoria for seven years. He said the Urban Pathways program helped him build healthier eating and exercise routines, which alleviated his Crohn’s disease after he spent three years homeless.
“Folks don't have the education necessary to take care of themselves," said Woods. "You eat what you eat, you purchase what you can afford, you purchase what tastes good, you purchase what's cheap. Habits are habits, but habits aren't always healthy.”
He said he's also learning to move his body to mitigate arthritis.
“I can cut down on three doses of Tylenol because my hands work and my elbows feel good,” he said.
Preventive care
Earlier this month, nurse Althea Lewis-Sewell was preparing to give residents their medication in the lobby of the Hughes House in the Bronx, where the Urban Pathways health program first started. Many of the residents take medication for diabetes, high blood pressure, schizophrenia or depression.
Lewis-Sewell greeted every resident by name. She reminded them to drink water and watched as they took their medications, which she pulled out of several thin drawers in her cart.
She said she’s there to provide whatever residents need, whether that's a referral to a doctor, reminders about their appointments or someone to go with them.
“Most of them will tell you ‘I'm not sick,’ so that's why they don't want to go to their physicals, but we said it's not being sick, it's about preventing you from getting sick,” said Lewis-Sewell. “Some of them have been on the streets for several years, and to come to a location where you have your own apartment and then it's like you're expected to be doing everything that you don't normally do, it can be a challenge.”
Hughes House, a supportive housing site in the Bronx managed by Urban Pathways, was the first to bring on a nurse on site. The program has expanded to seven other sites since.
She said ambulances used to come by the Bronx facility a couple of times a week when residents called with complaints of cramps, toothaches or stomachaches. But those calls have dropped dramatically: On a recent week in June, there were no calls for ambulance services.
A 2016 report by health insurer Excellus BlueCross BlueShield found common conditions like sore throats and headaches were responsible for more than 2 million visits to ERs across New York state, costing New Yorkers $1.3 billion. The study found that nine of out 10 visits were possibly preventable and could have been avoided or treated by primary care providers. An ER visit is almost eight times as expensive as seeing a doctor, according to the report.
Officials with the state Office of Mental Health, which funds Urban Pathways’ supportive housing programs, said providers can be flexible in how they use their funding, including by hiring nurses or supporting wellness programs.
“The agency is continually seeking opportunities to build upon or enhance the supportive services offered by funded providers in a manner that will advance our efforts to strengthen the mental health care system throughout New York state,” spokesperson Justin Mason said.
Lewis-Sewell said hospitals will often prescribe a patient the same medication they’re already supposed to be taking, so ensuring that Urban Pathways residents adhere to their medication regimens ultimately helps reduce avoidable visits.
Avery Kyser, another Urban Pathways resident, said that learning about his body and health helped him decide to stop smoking and drinking. He said he's been sober for three months.
“I wanted to do it for myself," Kyser said. "I'm trying to get a job. I got my blood pressure checked and I got my sugar checked."
"Yeah, I'm doing good," he added. "I take my medicine, take it daily every day.”
