Pacific Hospital Preservation & Development Authority: Bridging gaps in health care access

Project Details


The goal of the Permanent Supportive Housing Health Navigators program is to provide individualized healthcare to medically compromised DESC clients in permanent supportive housing, who are unable to be served through existing healthcare resources. DESC serves a population highly vulnerable to medical diseases and complications, which are further complicated by serious mental illnesses and behavioral disorders. Of those for whom DESC has physical health information, 41% are medically fragile and/or living with serious chronic diseases. That equals 547 individuals living in PSH programs who may need more intensive outreach and engagement services to attend to their physical health needs, and increased help in navigating complicated healthcare systems in order to do so. With this program, DESC will hire two new full-time Health Navigators and a portion of a supervisor, who will be able to serve those clients in DESC’s PSH programs who unable to be adequately served by community health providers or existing on-site Harborview or Neighborcare nurses. The work of the new PSH Health Navigators will result in increased access to medical care and improved health outcomes and a higher capacity for clients to successfully age in place.

Services to be provided by the Health Navigators will be prioritized (but not limited) to, in this order: PSH clients/tenants who are not eligible for Medicaid, and those who may receive Medicaid but are in need of more assertive and tailored outreach to make use of health services than limited capacity in some programs can provide due to the high caseloads for Clinical Support Specialists (CSS’s).  This will further be refined by prioritizing uninsured tenants living in PSH with the lowest CSS capacity on-site.

The program will also promote healthy group activities, led by the Health Navigators as able, and as desired in PSH programs. These activities may include nutrition education, walking clubs or other physical fitness field trips.

Project work will be supervised by DESC’s Director of Housing, in collaboration with the Director of
Clinical Programs (who oversees licensed behavioral health programs) and the Medical Director (who oversees psychiatric and psych nursing staff). DESC aims to serve 140 clients in the first year; the majority of enrollees will be served in the second half of the year due to recruitment, hiring, and initial ramping up of the program.

DESC anticipates higher rates of client engagement in and access to needed physical healthcare services, better understanding of and involvement in clients’ healthcare decision-making; improved chronic disease management; increased understanding of prevention and harm reduction strategies for daily life; and reduced social isolation due to mobility or other health-related constraints.

About Our Grantee

DESC - Downtown Emergency Service Center

DESC provides effective and affordable solutions to homelessness for our community's most vulnerable men and women through a nationally recognized interwoven network of care, housing, and support.

Visit DESC - Downtown Emergency Service Center website here.