November 26, 2013
By Jayne O’Donnell,
PHILADELPHIA — Amber Bailey used to travel up to an hour to see her baby’s pediatrician. That was when things were looking brighter and she was living in a house with her child’s father. She’s homeless now with two small children, but their doctor is only five minutes away, and medical care even comes to her shelter.
Health care may dominate the news these days, but it’s typically not on the minds of the homeless. But one children’s hospital and a generous donor here are making sure the most vulnerable members of this city’s struggling population remember the importance of their children’s and their own health care and coverage. And the thanks they receive from the families adds to the satisfaction they get from meeting some of the goals of the health care overhaul.
More than 20 years after Pennsylvania enacted its Children’s Health Insurance Program to get all kids covered by insurance, “the goal is to establish the same kind of model for adults that’s worked with the kids,” says Karen Hudson, program director of The Children’s Hospital of Philadelphia’s Homeless Health Initiative.
They may be pediatricians, but doctors at the Children’s Hospital of Philadelphia’s Karabots Primary Care Center here often urge parents who bring in their children for treatment to sign up for insurance or Medicaid to get health care for themselves, too. The work now extends to the mothers of the children in homeless shelters where CHOP doctors, nurses and other staff members volunteer to treat and teach. It’s an expansion of CHOPs 25-year-old Homeless Health Initiative. Along with encouraging medical coverage, the initiative brings nutrition, fitness and parenting classes to the world-weary adult residents of shelters run by the city.
“The mothers would tell us, ‘This is really great. We really appreciate CHOP coming here to take care of our children, but what about us?,'” says Hudson. “I know we are a pediatric hospital, but after I’d heard it a few times, I thought, ‘What can we do about this?'”
Hudson is building community relationships that she hopes will link the shelters to other healthcare providers who will treat the mothers, as some at Presbyterian Hospital here already have.
Like the Affordable Care Act’s focus on preventive care, the effort is designed to both keep people healthy and teach them not to use hospital emergency rooms as their primary care doctors. The more than $40 billion annual bill from what’s called “uncompensated care” at hospitals was a major motivating force behind the law.
Before she connected with Children’s Hospital at the shelter, Bailey says, doctors would just tell her to take her children to the emergency room, where she often waited hours.
“Say someone got shot. They’ll take them rather than look at a baby,” says Bailey. “Even if you have a sick baby, you’re prone to wait six hours to be seen.”
If patients don’t have insurance, emergency room visits can also result in big bills that can lead families to lose their homes and even children during extended stays, says Trish Downey, spokeswoman for People’s Emergency Center, the network of shelters CHOP works with. Visits by the hospital’s doctors and nurses and seminars on health and nutrition help assure ailments don’t lead to emergency visits.
The efforts will have long-term benefits for the families and cut healthcare costs, experts say.
“The research shows kids are not as likely to be up-to-date on their health care if their parents aren’t insured,” says Tricia Brooks, a fellow at Georgetown University Center for Children and Families. “Someone out there has to be triaging it. Parents need to be well themselves to be good parents.”
Still, the hospital has its work cut out for it. There were 131,000 uninsured parents in Pennsylvania with income under 133% of the poverty level, the point at which federal subsidies to buy health insurance on the new exchanges kick in, according to a report last year by the Georgetown’s Center for Children and Families. Of these, 25% have a child who is eligible but not enrolled in Medicaid or Children’s Health Insurance Program (CHIP).
Pennsylvania is one of the states that hasn’t expanded Medicaid under the ACA. That means for a family of three, a parent with an annual income between $7,421 and $19,530 — which is 100% of the federal poverty level — won’t be able to get financial help buying health insurance on the new exchange or qualify for Medicaid.
Children’s Hospital will help them apply and treat them anyway if they don’t qualify. Doctors and nurses from the Karabots center and other Children’s Hospital offices volunteer at the homeless shelters, but Karabots is so close to the shelters, the residents also come to the bright, cheerful two-story office building, which opened in February. It was funded in part by a $7.5 million donation from Nicholas Karabots and his wife, Athena.
Nicholas Karabots grew up in a cold-water flat in the South Bronx, where he was surrounded by drugs, guns and violence and involved in a gang. The one institution his struggling community could always rely on was nearby Lincoln Hospital (now Lincoln Medical Center), he says.
Now the owner of about 30 companies in the printing business, Karabots was determined to bring the connection and convenience of Lincoln Hospital to this city. The building merged several smaller offices from around the city and made pediatric care an accessible, attractive proposition for the inner-city poor and many others.
During a recent visit, Ciera Dawson was there with her nearly 1-year-old son, Jahsai, who is treated at the same facility where his mother’s former pediatrician practices. Dawson, a former Dollar Tree cashier now attending Penn State, says Karabots is “very high tech, there are more doctors, more workers and everyone’s nicer.”
Down the hall, physician Trude Haecker sees single father Brandon Williams huffing and puffing during a checkup for his ailing infant, Brandy. The baby, who will be 1 on Sunday, was born at 25 weeks of gestation, has chronic lung disease and couldn’t eat without a feeding tube until very recently.
Still, the talk turns to Williams’ own health. He has a family history of asthma, is overweight and uninsured. Haecker refers Williams to CHOP’s social workers, who link Brandy to the CHIP program and Williams to Medicaid. His process takes far longer, but he’s now covered and will be visiting a doctor in a few weeks. He wanted “to ensure he is healthy enough to care for his baby daughter,” says hospital spokeswoman Rachel Salis-Silverman.
As for Bailey, the CHOP programs are “helping me out to get myself together,” she says. “I’m stable now.”
Hudson says she’ll never forget the mother who “glowed in her gratitude” after she was able to save her baby’s life when the child stopped breathing. She used CPR, which CHOP nurses had recently taught at the shelter.
Karabots, who is a major publisher of puzzle books and magazines, says the “love and compassion” he feels when he visits the center that bears his name makes it all worthwhile.
“The amount of comments and thanks I’ve had from people in the community while visiting there are beyond description,” says Karabots. “I’m not Mr. Softie, but I become Mr. Softie.”
