Chandrawattie Ramnauth had the kind of back pain last fall that required a trip to the emergency room.
She was new to America and new to Schenectady, but emergency care was not hard to find. She followed the blue hospital signs to Ellis Medicine’s expanding ER on Nott Street, received care and was on her way.
A few years ago, that would have been that. Instead, the doctor who treated her asked enough questions to determine she had no primary care physician in her new country. Neither did her husband nor her four children — the youngest of whom would need vaccinations before starting school. None of them had health insurance.
So Ramnauth’s doctor set her up with an appointment at Ellis Medicine’s other campus on McClellan Street, which was St. Clare’s Hospital from 1949 to 2008. There, Ramnauth met Shanmattie Ramgoolam, one of three health service navigators who help people make their way through the maze of medical and social services.
“I came and she explained everything to me,” Ramnauth said. “She give me good advice about insurance, set up all appointments so the kids have shots for school because I don’t know how to do it. We new in the country, so it helped me a lot.”
Ramgoolam enrolled her in charity care, a type of free or low-cost care provided by hospitals to the uninsured or underinsured. She set her up with a primary care doctor on the McClellan campus. She followed up with Ramnauth after appointments the family had over the next few months to make sure everything went OK.
“Patients really tend to develop a trusting relationship with Shanmattie,” said Nicole Baptiste, who oversees the navigator program for Ellis. “They’ll come back anytime they encounter a barrier, because they feel comfortable that she can help them with whatever they may need — health insurance or transportation or immunizations or getting the children set up with care.”
The campus that once housed a full-service hospital and emergency room in the middle of the city’s poorest neighborhoods today has neither. The last of the former St. Clare’s Hospital — the emergency room — closed for good in December, more than six years after the hospital gave up its operating license to merge with Ellis.
But Ellis Medicine officials say the quality of care patients are getting is better than ever before, with the number of unnecessary ER visits down and the number of patients enrolled in primary care up. And the navigator program is largely to thank.
Ellis hired navigators in 2009 to help roll out its new medical home, a hub for outpatient care that would replace St. Clare’s on McClellan Street. Today, with the help of community partners that provide social services like housing, transportation and food, hospital leaders believe the campus is proof you don’t need a hospital on every corner to keep a community healthy.
“Over the years, we’ve seen an expansion in primary care,” said Baptiste. “When no one is here to help patients navigate the system, patients will oftentimes utilize the emergency department for routine care that they should be getting elsewhere. So as we’ve been helping them navigate the system, we’ve seen the need for more primary care.”
Ellis has grown its primary care offerings by extending its reach around the region with new practices in Clifton Park and Ballston Spa, and offering extended hours into the evenings and weekends. But it’s also doubled down on primary care in Schenectady by adding a new pediatric care and internal medicine practice at the McClellan campus, specifically to accommodate the needs of the community once it lost its hospital.
Some physicians have seen their patient loads grow exponentially as a result. Dr. Jianyu Li, a physician at the new internal medicine practice at the McClellan campus, started with about 50 patients and today serves around 500, Ellis officials said.
Before the ER closed, there was already an indication that the uptick in primary care enrollment might have something to do with the decrease in ER visits. At its peak, in 2000, the McClellan Street ER handled more than 38,000 visits. A few years after the St. Clare’s merger with Ellis, annual visits had dropped to 32,328 and were at 29,768 by the time it closed in December 2014.
Part of this was psychological, officials speculate. After St. Clare’s closed, Ellis let the community know it eventually planned to consolidate all ER services on the Nott Street campus. As a result, people began going to Nott Street for emergency care even before the McClellan ER closed. But hospital officials believe the drop-off was a result of the navigator program, which launched in 2009 and today serves about 115 patients a month.
“The medical home was really designed to take a certain segment of people out of the ED and get them into primary care,” said Ellis Medicine President and CEO Paul Milton. “So by getting people hooked up to primary care, we’ve been able to catch some of these illnesses and diseases early before they progress and patients wind up sick enough to end up in the ED.”
In addition to hooking up patients with primary care, navigators play a big role in helping residents out of jams.
“I just helped a client who was in the emergency room the other night for a toothache,” said Ramgoolam, one of the navigators. “He had an antibiotic to pick up but he didn’t have insurance. He wasn’t aware that he could get that medication free at Price Chopper.”
Navigators are trained to know about things like Price Chopper’s free antibiotics program or Wal-Mart’s $4 prescriptions, Baptiste said. They help you find out whether you’re eligible for government-sponsored insurance programs like Medicaid, Family Health Plus or Child Health Plus, and will even help with the applications. They inform residents of transportation options, like Medicaid vouchers and Ellis Medicine’s own community shuttle.
Ellis offers a free shuttle that makes twice-daily stops at six spots around the city, including the YMCA, YWCA, Salvation Army, Bethesda House, Schenectady Community Action Program and Hometown Health. Residents can get a ride to the McClellan Street campus and the hospital on Nott Street on weekdays and to Bellevue Woman’s Center in Niskayuna on Wednesdays.
And since health is inextricably linked to a patient’s socioeconomic status, a navigator’s job is also to help patients navigate their local social services. If a patient mentions they’re not sleeping well because they’re homeless, or they’re not eating right because they can only afford food for the kids, or their asthma is acting up because their landlord hasn’t taken care of a mold problem, the navigator will hook them up with the City Mission or the SICM Food Pantry or Schenectady County Public Health Services.
“We are here to fill in the gaps as services are being put in place,” Baptiste said.
Some in the community question Ellis’ vision for the McClellan campus. When the ER closed, staff was confident a consolidated ER on Nott Street would accommodate volume, but they felt they were leaving residents in the McClellan Street neighborhood without a safety net they had come to depend on over the years.
“They want an emergency room here, and if not an emergency room they want a clinic,” Rhonda Cady, a technician who worked at the McClellan ER since 1999, told the Gazette when the ER closed.
Almost immediately after the ER closed, wait times at the Nott Street ER started to creep up. At the peak of flu season, patients were waiting for hours, even days, only to leave in frustration without being seen. The ER is in the midst of expansion, with about 19,000 square feet still closed off as it’s under renovation. Management has said the wait times will level off once this wing opens, but nurses say the problem is chronic short staffing.
Ellis officials say there are no plans for a walk-in clinic at the McClellan Street campus, and they’re waiting to see how things shake out at the Nott Street campus before filling the old ER space on McClellan Street.
“Our plan all along has really been to smartly use our existing real estate,” Milton said. “Our McClellan and Nott Street campuses are pretty full right now, so we want to wait and see what kind of services the community may need before we fill that space.”
The transition to a medical home also helped Ellis serve some practical real estate needs. It realigned all its outpatient services so they would be in one place and then moved its nursing school from Erie Boulevard over to unused space on McClellan Street. It also houses a teaching program for family medicine and dental residents. Human resources and finance departments are also located there, purely because of space constraints at Nott Street.
“When I look back on what we’ve done, I’m proud of the realignment of services that allowed us to meet the needs of the general community and the community that’s centralized around that campus,” Milton said. “I think the initial fear after St. Clare’s closed dissipated quickly because of the commitment we made to provide services to the community. And we lived up to it and will continue to do so.”
Categories: -News-
