Lying in bed, her voice hushed to a whisper, Altagracia Gautier could manage only a few words at a time.
“Sometimes I forget to eat,” the 74-year-old woman, who has Parkinson’s disease, told the Florida International University medical student hovering by the bed in her Miami Gardens home. “I feel weak. My whole body shakes, and sometimes I can’t get out of bed by myself. I’m not getting better.”
The third-year student, Victor Becerra, calmly discussed Gautier’s symptoms, especially her tendency to become dizzy when standing. He smiled as he spoke and she appeared to relax under his scrutiny.
Becerra, 25, and two fellow FIU students — Romell McLeod and Matthew Tutterow, both working toward bachelor’s degrees in social work — were performing home visits on a recent afternoon as part of the university’s NeighborhoodHELP program, which provides medical care and assistance with legal issues and other matters to low-income residents of several communities, including Opa-locka, Hialeah, Miami Lakes, Little Haiti and North Miami.
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Launched four years ago, the program targets neighborhoods where surveys have shown a high incidence of infant mortality, cardiovascular problems, cancer and other afflictions. The students’ visits, supervised by FIU faculty members, are free. The service is particularly valuable for those people who remain ineligible for insurance coverage under the Affordable Care Act but who also cannot qualify for Medicaid because of Florida’s decision not to expand the program to those making up to 133 percent of the federal poverty level.
Residents of about 400 households, most of them identified with the help of community organizations, churches and schools, are now enrolled in the FIU program and receiving care from its students. Developing such hands-on skills is “an incredible experience” for the students and a crucial part of their education, Dr. John Rock, dean of FIU’s Herbert Wertheim College of Medicine, said during a recent meeting with Miami Herald editors and reporters.
“The entire household has to be considered,” Rock said, a reference to the program’s attempt to address every ailment that might afflict people living under a single roof. He noted that since the program’s inception, emergency-room visits by people it had treated were down by 60 percent.
The visit to Gautier’s house was the third for Becerra since July, when he responded to a request from the woman’s 42-year-old daughter, Vilma, for help with weight issues and proper nutrition. During that first visit, Becerra learned of the older woman’s struggle with Parkinson’s, and embarked on a program of care for her, too.
This visit to the house, where the family has lived for more than 40 years, was focused mostly on assessing the progression of the mother’s illness and of figuring out how to keep her comfortable and well fed. Vilma Gautier, who has no health insurance but whose mother is covered by Medicare, explained that she was having difficulty juggling the care of her increasingly delicate mother with the demands of a full-time job in a cargo company at Miami International Airport.
“I have to take off work to take her to the doctor,” she said, “and then make sure she’s settled and go back to work. Everything falls on me.”
Listening intently from the living-room couch was Dr. Annellys Hernandez, the FIU faculty member supervising the visit. She had not previously met the Gautiers. “What I’m hearing is that home service is going to be better for you,” Hernandez said, suggesting more frequent visits by the team.
Gautier said she usually leaves the house at 7 a.m. to take her 15-year-old son, Kelvin Stanley, to school, and then goes to work, leaving her mother by herself for most of the day, with only the dog, Fancy, for company.
“When she’s alone and she’s walking around, what if she suddenly feels dizzy?” Gautier pondered. “That’s what scares me.”
Tutterow, one of the student social workers, suggested that the older woman — whose dizzyness was ascribed to sudden drops in blood pressure when standing — be equipped with a Life Alert device so that she could summon help if she falls. Tutterow said he would find out whether it might be covered by her Medicare plan. “That’s something we’ll definitely write down and look into,” he promised.
Hernandez and the three students also determined that Altagracia Gautier would benefit from having Meals on Wheels deliver lunch to her.
Tutterow and the other social-work student, McLeod, said during a break that they always ask patients whether they have health insurance, but many do not.
“We didn’t get Medicaid expansion and we’re seeing the results of that on a daily basis,” Tutterow said. “In our roles we can see it on a community level — the lack of insurance and the difficulties people have in navigating the system. So we empower them to get care and make positive changes in their lives.”
Students in the program are assigned two households, each of which gets about four visits a year. Most teams include students in medicine, nursing and social work, plus a faculty member who might oversee 30 or 40 households. Law students are brought into the mix whenever legal barriers to healthcare arise, such as undocumented immigration status or problems with eligibility, housing or transportation.
In one current case, Hernandez said, a law student was being consulted about legal options for a mother of three children, the youngest just two months old, who is receiving no financial help from the children’s father since he left their home.
Team members will even help children with problems in school. During the visit to the Gautiers’ house, McLeod asked the teenager, Kelvin, about issues he was having in class, especially in biology. McLeod said he might be able to suggest a tutor for him.
The NeighborhoodHELP program is being funded largely by the Green Family Foundation, which was established in 1991 by a former U.S. ambassador to Singapore, Steven J. Green, and is dedicated to supporting social programs that address health issues and alleviate poverty, according to its website.
In many respects, the program addresses the question of “how a medical school can be integrated into a community,” said Rock, the dean. Team members refer patients for medical screenings for cervical and prostate cancers, mammograms, colonoscopies and other tests. Proper nutrition, he added, is paramount.
“If we can teach one person in a family how to eat properly,” he said, “we can prevent a disease.”
This story was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.