As the winter months get colder, little stands in the way of the elements for the thousands of people living unsheltered on the streets and subways.
An estimated 4,100 people were unsheltered, according to the city’s last annual count in Jan. 2024. The next so-called Homeless Outreach Population Estimate, the city’s tally of people living outside, will take place later this month.
The public hospital system’s street outreach program is one of the few among the city’s litany of initiatives that offers direct medical care through its fleet of mobile vans and roving clinicians. The service is often the only form of care for the people they encounter, who have been disconnected from the mainstream health care system, a problem exacerbated by unstable housing. The exposure can lead to severe physical and mental ailments and underpins the mental health crisis that has become a key focus of the Adams and Hochul administrations.
Most of the work of Health + Hospital’s Street Homeless Outreach + Wellness, or SHOW, is wound triage, especially in the winter months when hypothermia and frostbite are rampant. But beneath the surface is an attempt to use medical care to get people in the door and connected to other safety net services.
Not everyone accepts services. Since it launched in the spring of 2021, SHOW teams have had 250,000 interactions with homeless New Yorkers and provided on-site medical care in 32,000 cases, according to data provided by H+H. It is unclear whether the medical consultations are included in the total count of interactions. In January of 2023, the program began linking clients to H+H safety net clinics, which have seen 1,200 primary care referrals.
The program had a modest $14.5 million budget in fiscal year 2024, including $2.2 million from opioid settlement funds, said Operations Director Andy Cook. It also receives philanthropic donations and targets an additional $2 million in revenue from patients covered by Medicaid and other health plans.
Crain’s spoke with Cook and the program’s medical director, Dr. Yinan Lan, about the needs of the people they serve and the challenges of their work.
What are the main health care needs of the unsheltered people this time of year?
Cook: In the winter, we do special training with our team and prepare ourselves to be on the lookout for hypothermia, frostbite and skin tissue injuries…Is it something that we can handle? Is it something that someone should really go to the hospital for?
Lan: The extremity injuries are so common that I’m trying to think of a patient, or maybe a handful of patients…who don’t have exposure injury.
What do you do in those situations where someone really needs shelter to avoid more serious medical issues?
Lan: It’s tricky when it comes to someone who really needs to be either inpatient or somewhere that’s indoors, a little bit safer, but we’re kind of questioning whether [the client has] the capacity to make the right call. And that really comes up and it’s very different for very different situations. Even just hypothermia alone, or just in cold weather alone, it’s a very normal human response to have cognitive clouding, and it’s very challenging to think.
Cook: Securing emergency housing or emergency placement isn’t always guaranteed, but there is a pathway for us to request placement, working with [the Department of Homeless Services] and the shelter providers. There are also drop-in centers that we can connect people to. We try to employ all avenues to clinically assess and take care of a person, and then find the option, the solution that will work best for them and what they’re willing to do.
Mayor Eric Adams and Gov. Kathy Hochul have emphasized involuntary removal and treatment as a response to unsheltered people with untreated mental health needs. How does involuntary removal come into play in your work?
Lan: There are a lot of city-contracted street outreach teams that we kind of tag team with…it depends on who’s got a better bridge, and who might be more appropriate to do the engagement on any given day. We as a team do not do involuntary removal…For us, it’s all just relationship building…Every situation comes to a point [where a] certain intervention might break that bridge, break that trust or bond and whatnot, and then we have to decide for this case specifically, what’s the benefit that outweighs the risk here?
Have the people you work with shown more reluctance to be engaged by you or by strangers given the recent high-profile incidents of violence on the subway?
Cook: We’re very visible and very known to our patients and to others who are around. So, I would say that we haven’t seen any sort of, you know, negative impact or drop in engagement or utilization of services in that regard, and I think it stems from the history and relationships that our staff built with the people in the community.
