EARLY YEARS OF THE EPIDEMIC
Commonwealth Land Trust has provided housing and supportive services to homeless individuals living with HIV/AIDS since 1990. During the early years of the epidemic, many individuals living with HIV/AIDS suffered rapid heath declines and displayed visible symptoms of the disease. They faced discrimination, unemployment, poverty, and homelessness.
Individuals who contracted the disease through injection drug use had an especially difficult time securing housing, as many agencies required clients to achieve three months of sobriety in order to qualify for housing. CLT was one of the first affordable housing providers to practice a housing first approach and admit clients struggling with addiction. During the early years of the epidemic, CLT focused on direct treatment of the disease. Nursing staff was employed at several of our properties, providing medical treatment and hospice care.
Dramatic improvements in the effectiveness of HIV/AIDS treatment have caused a significant shift in the makeup of our resident population. Today, most Americans living with HIV/AIDS are able to maintain their health, sustain employment, and lead independent lives. HIV positive individuals struggling with addictions, mental health challenges, and histories of incarceration, however, are at high risk for homelessness and early mortality.
These needs-intensive individuals now constitute the majority of our HIV positive resident population. Many have histories of trauma exposure, posttraumatic stress disorder, and other mental illnesses, and 80% are struggling with addiction. While living on the streets, many residents found adherence to complex HIV regimens nearly impossible to maintain, exacerbating their other health challenges and fueling a cycle of depression, addiction, and homelessness. Research demonstrates that homeless individuals experience dramatic improvements in mental and physical health when they receive permanent, affordable housing in conjunction with on-site case management services.
ON-SITE MEDICAL CASE MANAGEMENT SERVICES
CLT provides the on-site medical case management necessary for our residents to address their challenges and rebuild their lives. Once our clients are housed, case managers ensure that their basic needs are met. Residents are provided with a furnished room, consisting of a bed, dresser, microwave, refrigerator, sink, and nightstand, as well as access to an on-site food pantry.
Within two weeks of move in, residents meet with their case manager and complete a thorough Needs Assessment and Individual Service Plan. Case managers assess clients’ current health care and level of medication adherence. Those clients not linked with primary care physicians are assisted in selecting appropriate medical care. Medical case managers encourage clients to create a health care team that includes primary care physicians, mental health care and substance abuse treatment professionals, as well as other necessary providers. CLT receives funding from the Department of Public Health and the HOPWA (Housing Opportunities for People with AIDS) program to provide medical case management to clients living with HIV/AIDS.
The overarching objective of our on-site medical case management model is to provide residents with the support necessary to manage their health, increase their self-sufficiency, and live independently. Services are provided along a continuum of intensity, which varies depending on the needs of the client. Residents who are in a state of crisis, or who have a history of high-risk behaviors, receive services on a weekly basis, whereas residents who have attained a higher level of self-sufficiency receive services on a bi-monthly basis. Medical case managers provide mental health care, substance abuse counseling, basic life skills, financial literacy training, and HIV-focused nutrition classes. In addition, they coordinate with other providers to keep clients engaged in care outside the building.
In addition to direct case management services, clients’ interpersonal skills are improved with in-house activities and planned outings, such as movie nights, book clubs, support groups, holiday celebrations, and volunteer trips. These activities provide a venue for clients to support one another and foster a sense of community that is particularly beneficial for clients who lack close social networks. CLT also hosts quarterly Resident Advisory Board meetings where clients meet with our case management and supportive housing teams. Clients provide feedback, offer suggestions, and take an active role in shaping the housing and supportive services they receive.