For the last ten year the Montefiore Care for the Homeless Team has provided health care to a diverse homeless population of the Bronx, New York. Homeless persons are seen at soup kitchens, family shelters, and a women's assessment shelter. The team includes nurse practitioners, a supervising physician, an psychiatric clinical nurse specialist, a social worker, a health educator, and medical assistants. Yearly descriptions of patient demographics, continuity measures, diagnoses, interventions, and referral patterns are presented over a four-year period. These reveal that an increasing number and diversity of services have been provided by nurse practitioners who address social problems and preventive care in addition to providing direct clinical care for a range of acute and chronic health problems. Providing services on-site premises has been a strategy to build relationships with shelter and soup kitchen staff, improve patient participation, and foster social support. Close affiliation with a community health center provides a reliable referral resource and readily available physician consultation. A multidisciplinary team approach addresses barriers to health care services for the homeless population and contributes to improved provider retention. (Authors)
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