It’s a warm summer day in Sacramento and Amanda Buccina, a registered nurse, has just arrived at Johnston Park to see her second patient of the day. Brian is a 68-year-old man diagnosed with leukemia and chronic obstructive pulmonary disease. Although he worked his entire life, Brian’s health conditions caused him to lose both his job and ability to pay rent.

As part of the Street Nurse program launched by WellSpace Health in March 2016 and funded by Sutter Health, Buccina and another nurse, Rennie Jemmings, provide care to the medically fragile homeless population in Sacramento. Five days a week, they take to the streets to care for homeless residents who live under bridges, in alleys or in tents along the river.

A primary provider of health services for homeless residents in Sacramento, WellSpace offers three health centers in downtown and midtown, as well as a walk-in clinic. According to Gwendolyn Jenkins, a registered nurse and program manager of the Interim Care Program at Wellspace, the street nurse program has served more than 660 homeless residents since its creation.

On any given night, 3,665 people experience homelessness in Sacramento, according to a 2017 report from the nonprofit Sacramento Steps Forward. The number of homeless people in Sacramento increased 30 percent between 2015 and 2017.

“While street medicine isn’t new, it continues to be a growing field,” said Christie Gonzales, behavioral health operations director for WellSpace Health.

“It takes a special kind of nurse to walk the streets of our city, often tracking down patients, and ensuring they get the medical care and follow through they need,” she said.

Some homeless health care programs offer a medical team approach, but Gonzales notes that seeing the same two Sacramento street nurses helps homeless residents build a sense of trust. The two nurses work closely with a community navigator, a position created in partnership with Sutter Medical Center, Sacramento and Sacramento Steps Forward, a local non-profit working to end homelessness. The nurses and community navigator work together to link homeless residents to housing and help them access community health services including emergency shelters and alcohol or drug rehab programs.

“A typical day for our two nurses includes walking and driving around Sacramento to provide basic medical services, including wound care; helping to manage chronic medical conditions such as diabetes, high blood pressure; and connecting clients to community resources,” Jenkins said.

‘Gives Our Community Hope’

Before providing critical services, Buccina first works to build rapport with patients. Some homeless residents have had poor experiences with health care providers in the past, and as a result, they often delay seeking medical care until their health becomes an emergency.

“It can take multiple encounters before a patient trusts me enough to accept services or treatment,” Buccina said. “Once I’ve gained their trust, I assess their physical and behavioral health needs.”

Brian was one of those patients. Buccina remembers seeing him from afar when she visited the homeless camp on the Sacramento River. Although he was always respectful, Brian, who declined to give his last name, kept his distance.

“One day while caring for others at the camp, I noticed Brian was bleeding from his ear,” Buccina said. “He looked depressed and scared, and I offered to take him to the ER to get his ear checked.”

Doctors diagnosed Brian with a ruptured eardrum. That initial contact also opened the door for Buccina to help Brian get referrals to an oncologist for his leukemia and a pulmonologist who could treat his pulmonary disease.

“Amanda is a godsend,” Brian said tearing up as Buccina placed a pulse oximeter on his finger to check his oxygen levels. “She’s so efficient and so genuine that people just love her.”

Since their first encounter, Brian has become a health care advocate for others in the homeless encampment, encouraging them to see Buccina for health problems. He also recently obtained housing and said Buccina has given him hope.

“She’s stretching whatever time I have left,” Brian said. “She helps people navigate the health care maze and she has great qualifications and gives our community hope.”

Buccina’s next appointment for the day has canceled. She has worked for over a year to get him connected with mental health services, but he told her he didn’t feel well enough to go.

“He needs an advocate,” said Buccina, who has worked as both a physical and mental health nurse. “He’s afraid to seek help, so I’ll just encourage him until he’s ready.”

Her third appointment for the day is a homeless woman who is in the hospital. Not only does Buccina visit her patients when they are hospitalized, she also wants to discuss her discharge plans and continued wound care.

“I’m there when clients need support, medical care and sometimes just someone to listen,” Buccina said.

Expanding to the Central Valley

Kelly Brenk, manager of Community Health for Sutter Health’s Valley Area, said the Sacramento street nurse program is also part of Sutter Health’s regional “Getting to Zero.” campaign. The initiative, launched in Placer, Sacramento and Yolo counties, strives to end homelessness. Using the national Housing First model, that initiative plans to find homeless residents stable housing before providing support services.

“The Street Nurse pilot program has been so successful that we added a second nurse this year,” Brenk said.

In May, Sutter Health launched a similar street medicine team in the Central Valley in collaboration with Golden Valley Health Centers. The Central Valley street medicine team is composed of a licensed vocational nurse and community health workers from Golden Valley who travel through Modesto and Los Banos. The team has a van they use to visit specific locations throughout those cities and provide basic health care to homeless residents.

Brenk said that although Sutter Health doesn’t have raw numbers on whether the Street Nurse program has led to a reduction in emergency visits among homeless people, the program is considered a success and a critical component in the continuum of care.

“The Street Nurse program is addressing the urgent needs of the homeless while also linking them to services they desperately need,” Brenk said.