After 18 years living on the streets, Richard Warhurst was finally housed. He got a voucher from The Father’s Heart, a Clackamas County homeless services organization, to rent a second-story apartment in a quiet complex surrounding a pool. Finally, he was warm and dry and had somewhere reliably safe to sleep each night.
Six weeks later, he suffered a massive stroke that left him barely able to speak or walk.
He went to the emergency room, and doctors managed to get him stabilized. Doctors recommended he stay for recovery. Warhurst, 66, knew he had insurance. But after nearly two decades living outside, he didn’t have the paperwork to prove it.
“Finally I got tired of telling them that,” Warhurst said. “I went home on my own because I didn’t want all the bills.”
Without insurance, he had no way to access rehabilitation services.
“I went home and sat there for four months,” he said in an interview inside his new, ground-floor unit. “If it wasn’t for her I wouldn’t be here now.”
Sitting next to Warhurst was Lynn Gaffney, lead care coordinator at The Father’s Heart, who met Warhurst four months after his stroke. He was the first client she brought to a special virtual meeting for a new program in Clackamas County. It was designed to help homeless services providers like Gaffney coordinate with health care providers to navigate the byzantine snarl that insurance can pose for people who are experiencing homelessness.
Two days after they met, Gaffney had the answers Warhurst had lacked for more than a decade. He was already fully insured under Medicare, but a data entry error had prevented him from accessing his benefits when he needed them most.
“The ‘Sr.’ on the end of my name is what messed everything up,” Warhurst said. “That’s all it was.”
One year later, Warhurst is able to walk and talk again. He visits friends in the apartment complex and rides his e-bike to the grocery store. And he’s put 40 pounds on his formerly spindly frame.
And he continually expresses gratitude for Gaffney, who visits him every Thursday.
“If they hadn't sent you over here, I’d probably still be upstairs rotting in that apartment,” he told her.
New funding for a game-changing program
It might seem obvious that people who are homeless tend to lack access to health care — and get sicker as a result. But homeless service providers were hitting walls when trying to help clients navigate situations like Warhurst's. That began to change in 2023 with the emergence of county pilot projects that have now helped hundreds of people like Warhurst to access health care. Today, providers like Gaffney are able to navigate in an afternoon questions that previously seemed unanswerable.
Twice a month, homeless services providers meet virtually with a panel of healthcare specialists to walk through up to three questions about their clients’ healthcare needs. It’s a process called case conferencing, and those involved say it could be transformative.
In the spring of 2023, Washington County Homeless Services launched a pilot project in partnership with Kaiser and Providence. Clackamas County began a corresponding project in March 2024, as did Multnomah County in November.
The nonprofit Northwest Pilot Project works to reduce housing insecurity among elders. The organization is not in the health care business, but workers there were continually running into a brick wall when trying to help clients access the health care they needed.
“Folks who are chronically homeless – their health deteriorates, they age faster and they have a higher need for basic health care services,” said Laura Golino de Lovato, executive director of Northwest Pilot Project. “But they have a harder time accessing those services.”
Chronic homelessness is defined as either living outside for over a year, or having multiple instances of homelessness over several years. People living outside might not know who their doctor is, or even that they qualify for health care coverage.
“Those of us who are housed and have health care coverage often take that for granted,” Golino de Lovato said. “We may not think about, ‘What if I don’t get this wound treated? What if I don't get this sprained ankle taken care of and it doesn’t heal right?’”
Because of the success of case conferencing, Metro is funding a regional program to strengthen and formalize the process. Members of the regional government’s oversight council on supportive housing services voted unanimously April 28 to clear the way for Metro to continue working with Health Share providers and the counties in an expanded regional system.
Metro also approved $1.8 million in funding from the Supportive Housing Services Tax for the three counties to continue integrating health care and homeless services, including expanding case conferencing. The regional body also spent $400,000 to fund a pilot project at Health Share of Oregon, which pays the salaries of three employees dedicated to that integration work.
“It all started with case conferencing, but then we realized there's so much more here and that the value in working together is so much better than working separately,” said Adam Peterson, Health Share’s portfolio manager for health care and homeless services integration.
Health Share has already signed a data sharing agreement with Multnomah County and is working on a similar agreement with Clackamas and Washington counties. Peterson is hopeful that the program will not only improve health care access to individual clients, but also improve the way big providers like Health Share allocate services.
“What we’re hoping it will do is identify needs at a much earlier stage,” Peterson said. “If we knew, let’s say, that one shelter site had a ton of a certain type of medical need, then we could take that type of care into that shelter. So we could tailor our investments to the population.
“Or if we knew a lot of our folks are discharging from a hospital to a certain shelter site, then we would be able to provide that shelter with additional resources. So we're really hoping to build this better system of care through that shared information.”
Over the years, Golino de Lovato and those she works with saw how detrimental it can be to arbitrarily separate basic human needs like shelter and health care.
“Think about it this way,” Golino de Lovato said. “You live in a tent, you have no running water, you have no heating or way to cool off and you have an abscess or a fever. It's going to be hard to get well in that situation.”
The reverse is also true, she added.
“It's not just about getting them into a motel or an apartment. It's about making sure they’re getting access to food and health care. That could be behavioral health as well. And when they get that, they are more likely to stay stable in housing. And they’re more likely to get well when they have stable housing.”
Navigating confidentiality
Before this program began, Gaffney said navigating health privacy laws made it “nearly impossible” to connect her clients with the health care they needed.
Many people living outside don’t have their identification or health insurance information. They may have lost enrollment cards and important paperwork in inclement weather or during sweeps, when county or city governments clear away camps and remove belongings. Often, people experiencing homelessness no longer know who their primary care doctor is, or even which entity provides their insurance.
To find answers to these basic questions, Gaffney would need clients to sign a release of information, or ROI, for every phone call she needed to make on their behalf. Each call might require an hour of waiting on hold, only to find out who to call next. By then, her client might be gone and difficult to contact until their next meeting. So the process would drag out interminably.
“For one client, I may need to make 10 phone calls, " Gaffney said. “And because they are homeless or recently housed, it was almost impossible. It was so hard and so crazy sad sometimes.”
All that changed when Clackamas County began case conferencing a little more than one year ago.
“Now they can sign one ROI and it lists 20 different entities that are in that meeting,” Gaffney said. “We've already talked about what's most important to (clients) and they can pick three things to ask about. For a lot of them, it's just: who’s my doctor, what’s my plan and where can I go for an appointment.”
Gaffney estimated that she’s helped about 100 people in the past year through the program.
“I think we've case conferenced 70 people, but the knowledge I’ve learned I've been able to pass on to others,” she said. “Once we got this program going, it was a life-changer. It's been life-altering for people.”
Gaffney said case conferencing transformed her work days from making endless calls on behalf of one or two people, and never seeming to get traction to being able to get real answers for three or four people in one day.
“Now, we’re making progress,” she said.
‘Housing actually is health’
Working together means better results on both ends – both for housing people and for helping them improve their health, said Golino de Lovato.
“We've identified in the studies that housing actually is health,” she said. “The health care system wants to take advantage of that. They want the people they’re seeing in the emergency room to get well. So we want the same things.”
“If a client comes to us and says, I need housing, but also I have a bad tear in my rotator cuff that’s not being treated. We want to refer them to their doctor, but we often don’t know who that is.
“And on the other side, what if a health care provider has treated someone in the E.R., but they’re getting ready to send them back to their tent? How do they know who to call to say, ‘Can you help this person get into housing?’
“So it’s about setting up clear communication. Once that is established, amazing things can happen.”
