Neighborhood Nursing brings healthcare to people’s doorsteps in vulnerable communities

In the city of Baltimore, 94 percent of residents have some form of health insurance. Yet many face alarming disparities including higher rates of chronic diseases and shorter life spans. One program is trying to overcome barriers by providing healthcare straight to people’s doorsteps. Special correspondent Christopher Booker reports.
Geoff Bennett:
In the city of Baltimore, 94 percent of residents there have some form of health insurance, yet many face alarming disparities, including higher rates of chronic diseases and shorter life spans.
As special correspondent Christopher Booker reports, one program is trying to overcome barriers by providing health care straight to people’s doorsteps.
Woman:
Hey, sweetie. You want your blood pressure checked today?
Christopher Booker:
Tuesday mornings are busy in Johnston Square Apartments in East Baltimore. Set up in the lobby, nurses offer free basic checkups for anyone who may be passing through;71-year-old Lavern Clark has lived here for six years, and these weekly nurse visits have become part of her routine.
Lavern Clark, Resident, Johnston Square:
Make sure my heart rate is good. It really helped me a lot with all my medications.
Christopher Booker:
Nurses say many in this predominantly Black neighborhood face barriers to health care. There is a shortage of primary health care doctors and transportation to providers can be difficult.
Tiffany Riser, Neighborhood Nursing:
This community is insured. But if you ask them when’s the last time you have seen your provider or do you have the medications that you need, that’s where things fall apart.
Christopher Booker:
Tiffany Riser is a nurse practitioner and part of this pilot project that organizers call Neighborhood Nursing.
Launched in January, the aim is to bring health care to communities block by block.
Tiffany Riser:
If you remember, back in the good old days, doctors used to make house calls quite regularly, and now that’s quite a rare thing. And that disconnect, I think, is what led to our health care system forgetting that this is where people spend most of their time.
When you see them in their home, you really get an in-depth understanding of the challenges that they’re facing.
Man:
Because he break it down by needs, then broke it down by insurance.
Christopher Booker:
The team consists of nurses and a community health care worker who helps residents work through any problems they have accessing health care.
Andrew Hampton, Resident, Johnston Square:
I lost a wallet, really.
Christopher Booker:
Oh. What was in your wallet?
Andrew Hampton:
All of my identification, all of my important papers.
Christopher Booker:
Seventy-nine-year-old Andrew Hampton hadn’t seen a primary care physician in years, partly because he didn’t have any identification.
The team helped him replace his I.D. and recently scheduled an appointment with a doctor.
Tiffany Riser:
We’re hoping that with this recent visit we’re able to get him plugged into the care that he already is covered for and has paid into.
Christopher Booker:
Right.
Tiffany Riser:
Just a matter of getting it to his front door.
Christopher Booker:
America spends more per capita on health care than any other high-income country. Yet we have the lowest life expectancy at birth, the highest rates of death for treatable or avoidable conditions, and the highest rates of infant and maternal mortality.
Experts say making preventative primary care more accessible through programs like this one in Baltimore could make a difference.
Sarah Szanton, Dean, Johns Hopkins School of Nursing: If we can do it universally, where everyone gets it, where it’s like a right, like a utility, then we will be able to reach the promise of preventive care that is not just reactive and that we’re preventing things for everyone and everyone could be at their greatest health.
Christopher Booker:
Sarah Szanton is the dean of the Johns Hopkins School of Nursing and leads the philanthropy-funded program. A collaboration with the University of Maryland, Morgan State, and Coppin State schools of nursing, she says by next year they plan to bring primary health care to more than 4,000 Baltimore residents, regardless of their insurance coverage.
Sarah Szanton:
The vision is that we will go door to door and be in the laundromat, in the libraries, in the schools, sort of blanket it, so that everyone has access to a nurse and community health worker.
Christopher Booker:
The approach was inspired by a public health program developed more than 1,000 miles away in Costa Rica, where health care workers aim to visit every resident nationwide in their home at least once a year.
Dr. Asaf Bitton, Harvard T.H. Chan School of Public Health: They might come back to visit them if they have high needs. They might connect them with other parts of the public health or nutrition system. And all the time, they connect them with the acute and chronic care that that person might need.
Christopher Booker:
Harvard School of Public Health’s Dr. Asaf Bitton has studied the impact of Costa Rica’s model.
Dr. Asaf Bitton:
Costa Rica has significantly improved the health of its population across both what we call communicable diseases — those are infectious diseases that can often be prevented with vaccines and other antibiotics — as well as noncommunicable diseases.
Christopher Booker:
Costa Rica has achieved those better health outcomes while spending less than a 10th of what the U.S. spends per person health care.
Melinda Abrams, The Commonwealth Fund:
We tend to focus on people who are sick, as opposed to focusing on keeping people well or identifying problems early to help avoid more serious problems later on.
Christopher Booker:
Melinda Abrams is the executive vice president for programs at The Commonwealth Fund, a health care research organization.
She says the complicated nature of health care in the United States would make it difficult to expand a program like Neighborhood Nursing beyond Baltimore.
Melinda Abrams:
The major barrier right now, in my opinion, is the financing. We tend to focus on hospitalizations and specialty. We’re really focused on individual services, which incentivizes more volume, as opposed to having clinicians be accountable for both the quality and outcomes for patient and patient care.
Christopher Booker:
Back at Johnston Square Apartments, this new approach has started to see small wins. Calls to 911 from the building are down. And organizers say the community has started to take the effort beyond the weekly checkups.
Regina Hammond, Resident, Johnston Square:
I went to a meeting where it was shared with me that people in my zip code, this area, our life expectancy is not as long as in other areas. And that bothered me.
Christopher Booker:
Longtime resident Regina Hammond suggested the nurses help create a neighborhood exercise group. They now take weekly walks. And on days when it’s too hot, they work out indoors.
Why was there a need for a walking group?
Regina Hammond:
Because a lot of people don’t venture too far because they don’t want to walk alone. Some people don’t feel safe. It’s about getting out. It’s about learning who’s in your neighborhood. It’s about looking at beautiful flowers, being able to talk with a nurse walking beside you, talking to them about things that nobody took the time to listen to you about.
So it’s serving a lot of purposes.
Christopher Booker:
She hopes to see this initiative grow beyond her neighborhood.
That, Abrams says, is possible, but will require collaboration.
Melinda Abrams:
What it would take is federal policymakers, state policymakers, the hospitals, the doctors, and the insurance companies to come together to agree to pivot and invest more on prevention and primary care.
No mistake, that is very hard to do. But I’m optimistic, because there are a number of communities that are experimenting with this right now.
Woman:
It was 115 over 70.
Christopher Booker:
But, for now, in this community, these nurses will keep showing up week after week.
For the PBS “News Hour,” I’m Christopher Booker in Baltimore.