Emergency physician researcher. Health x Housing Lab Co-Director. @EMxSDOH_lab PI. @CDUHR_NYC affiliate. Tweets my own / not my employer's. RT≠endorse
Jul 25, 2023 • 10 tweets • 2 min read
Long awaited results of the Accountable Health Communities project are out and... well... somewhat confusing / underwhelming. A brief 🧵. (1/)
What were Accountable Health Communities (AHCs)? This was a big Centers for Medicare and Medicaid Services pilot starting 2017 that (to simplify a lot!) funded 32 agencies to screen for & address patient social needs (things like food insecurity, housing insecurity, etc.) 2/
Dec 7, 2022 • 10 tweets • 2 min read
NYC paramedic @AnthonyAlmojera (who also has lived experience of NYC homelessness) describes here why the Mayor’s plan related to involuntary hospital transport of people experiencing homelessness is “not the answer”. (1/) nytimes.com/2022/12/07/opi…
First, he notes that this isn’t even particularly new (though “makes splashy headlines”) — already EMS responds to calls for hundreds of “emotionally disturbed patients” daily, already they bring in people experiencing homelessness who are in mental health crisis. (2/)
Feb 18, 2022 • 14 tweets • 3 min read
I've now read the full "Subway Safety Plan" and have...some thoughts. There are some glimpses of good here amidst the bad but I'll start by saying that the idea of "subway safety" being the framing for the city's plan to address unsheltered homelessness makes my heart heavy... 1/
Good: the plan starts by saying that we shouldn't conflate homelessness & crime, & notes that people experiencing homelessness are more likely to be victims of crime than to commit crime...
...Yet the actual provisions move us in a direction of criminalizing homelessness. 2/
Feb 18, 2022 • 4 tweets • 2 min read
I agree with @JoshDeanNYC. I work in an ED and see a lot of folks, most of them homeless, brought in by police. Presence of police does not foster a therapeutic relationship, and does not imbue people with the trust they need to freely “accept offers of services.” (1/)
The police agree:
“A law-enforcement source didn’t hold out high hopes for success.
‘I don’t have any reason to believe that it will be any more successful than any other homelessness effort…There’s people on the subways because they’re afraid to stay in the shelter system.’” 2/
Feb 17, 2022 • 4 tweets • 2 min read
Excellent report comparing medical respite to other levels of health care services and describing barriers that people experiencing homelessness face to receiving the level of health-related care they may need, from @NatlInstMRCare (1/) nimrc.org/wp-content/upl…
I’ll put it more bluntly than they do: medical respite programs cannot just be the “easy discharge option” for hospitals to send people to who may need a much higher level of care than respite can generally provide (some might call this “patient dumping”). (2/)
Apr 23, 2021 • 11 tweets • 2 min read
🚨NY Dept of Health (@nycHealthy) put out an alert today about increased cases of Hepatitis A seen among people who are homeless, use drugs, or were recently incarcerated. EDs and other locations serving these populations urged to vaccinate. (1/)
The alert did not have specifics on numbers but said the increase in cases had been observed since Dec 2020. We have seen similar outbreaks nationwide in the past several years. (2/)
Mar 17, 2021 • 10 tweets • 3 min read
Heartbroken to share that my first role model in life and academia – my mom – died yesterday of ovarian cancer. She was remarkable – I want to share a bit of her story… (1/) tributearchive.com/obituaries/203…
When I was born my mom was a high school teacher. She actually went into labor – 2 months early due to a placental abruption – while she was teaching. Thankfully, and one crash c-section later, we both made it. (2/)
Dec 9, 2020 • 9 tweets • 2 min read
I wish I hadn’t predicted this would happen... and we are just in early December. Some thoughts... (1/)
The subways should be reopened immediately. There are other ways to clean the subways that are not be violent to homeless people. (2/)
Dec 8, 2020 • 6 tweets • 1 min read
ICYMI: recent report to Congress from HHS details ways that states can and are already using their Medicaid programs to provide housing-related services and supports for people with substance use disorder. (1/) medicaid.gov/medicaid/benef…
It's quite thorough and detailed (Medicaid waivers are a bit of a numbers soup!), with several case studies. I'm pleased to see the clear recognition that housing is a key issue for people who have substance use disorders. (2/)
Dec 7, 2020 • 7 tweets • 2 min read
I can’t even express how strongly I agree with this. A few thoughts...
Congregate shelters were designed not with dignity, humanity, or equity in mind but for the convenience (and cost) to governments and providers. (2/)
Dec 6, 2020 • 7 tweets • 1 min read
No surprises here: 55 test positive for coronavirus at San Diego Convention Center shelter (1/) 10news.com/news/local-new…
We are going to see more and more of this as COVID-19 increases across the country. Experts have said for a long time that congregate settings like this are not safe. (2/)
Aug 26, 2020 • 12 tweets • 4 min read
That a small group of #UWS residents prefers to risk the health of hundreds of homeless New Yorkers than to see them in their neighborhood is disheartening to say the least. Here’s a thread with some facts amidst this noise. (1/)
1st: framing this as a move "so they can get services in shelters" is a bold-faced lie. The hotels are operated *by the identical nonprofits* that operate the shelters from which these individuals came. Services are available in the hotels, as they are in the shelters. (2/)
May 27, 2020 • 8 tweets • 3 min read
Cause of death: racism. #GeorgeFloyd (1/)
Tonight I can’t get the voice of one of my patients, a black homeless man, out of my head: “they treat us like stray dogs.” (2/)
May 16, 2020 • 10 tweets • 4 min read
🚨NYC Health Dept @nycHealthy released new guidance today on SARS-CoV-2 testing and symptoms. Brief thread of highlights—includes some directly relevant to #homelessness sector. www1.nyc.gov/assets/doh/dow… (1/)
The background is that NYC DOHMH preciously recommended SARS-CoV-2 testing primarily only for those sick enough to be hospitalized, for several rational reasons related to local conditions & testing capacity (I have a now-ancient thread on it). (2/)
May 14, 2020 • 11 tweets • 4 min read
There is a completely inhumane health disaster happening right before our eyes in NYC. #COVID19 (1/) thecity.nyc/2020/05/homele…
This photo was taken *this week* at the large shelter next door to @BellevueHosp. These are men who had been removed from the subway during its unprecedented nighttime closure. (2/)
May 11, 2020 • 13 tweets • 4 min read
Kudos to @BrianLehrer for asking the right questions on NYC subway closures and clearing of people experiencing homelessness. Worth a listen. A 🧵 with some highlights (1/)
He saw through Mayor's spin: "So only 10% of the homeless people they [NYPD] encountered on night 1 had extended interactions [w/outreach teams] & only 5%, half of that, agreed to go to a shelter. The Mayor called that a success. One could argue that isn’t a lot of success…” (2/
May 6, 2020 • 10 tweets • 3 min read
I'm shaking. Tonight in NYC more than 1,000 NYPD officers will descend underground to clear our homeless neighbors out of the subway trains and stations. 1,000 police moving 2,000+ (based on last released PIT estimate) human beings. (1/) nypost.com/2020/05/05/ove…
As I had feared (given the vastness of the NYC subway system and the relative paucity of homeless outreach workers), this Post article reports outreach teams will only be at end of lines, police will handle the rest of the system. (2/)
Mar 22, 2020 • 6 tweets • 3 min read
Very important info for people following the news on #COVID19 in NYC: you will see what seems to be a very high, concerning hospitalization rate. This is because in NYC @nycHealthy requests we test only for patients being hospitalized. (1/)
Obviously that affects who is tested & the overall denominator. So you cannot and should not look at NYC’s #COVID19 hospitalization rate and assume that X% of all people with COVID require hospitalization. It’s an artifact of who is tested. (2/)
Mar 5, 2020 • 13 tweets • 4 min read
Important: @nycHealthy has released interim guidance for #homeless shelters on COVID-19 (thank you @nycHealthy). Other communities might find these useful too. I’ll pull out just a few highlights in a thread. (1/) www1.nyc.gov/assets/doh/dow…
For shelter residents who have fever or respiratory symptoms and have been evaluated for COVID-19 but don’t meet testing criteria: (2/)
