One thing that strikes me whenever I deal with people at the bottom of the old socioeconomic ladder is the gulf that separates them from the middle-class people who so often call the shots in their lives, people like social services caseworkers, police officers, and landlords, a gulf defined by different ways of looking at the world and different ways of acting.
It has long struck Mike Saccocio, too, at City Mission of Schenectady, and it began to strike people at Ellis Hospital a few years ago when that hospital absorbed the former St. Clare’s and took over the medical care of poor people, which had been St. Clare’s specialty.
People on the bottom rungs of the ladder come late to appointments or miss them altogether, they take umbrage at minor slights, they don’t tend to their needs until those needs become an emergency. It’s frustrating to middle-class professionals who are trying to help them.
So Saccocio and Ellis got together, each side from its own perspective, and the result is a way of doing things at the new expanded Ellis that provides better care to patients and is more cost-effective for the hospital as well.
It depends on insights derived from experiences as mundane as administrators taking a bus to the hospital, just to see what it’s like, and finding how hugely inconvenient it is when one bus is five minutes late so the passenger misses a connection and then has to choose between waiting an hour for the next bus or making a long walk, then imagining what that would be like in freezing weather with an infant in a stroller to contend with, which is the sort of thing that poor people deal with all the time.
“How can we say, ‘You’re 15 minutes late, we can’t see you?’ ” asked Anna Gelman, administrator of the Family Health department after the bus experiment. One of the results was that Ellis developed its own minivan shuttle system to make the rounds of the city’s shelters and social-service centers. Another was that it provided for “open scheduling,” meaning no fixed appointments, for some of its services.
The hospital’s Family Health department is really the primary care department, the equivalent of a family doctor, where patients are directed if that’s more fitting than the emergency room, which is where poor people without insurance often head if they have a health problem.
Getting people into primary care is one of the main goals of the program.
Saccocio had gotten involved in a national program called “Aha! Process,” which trains professionals to “build bridges out of poverty,” as it’s called, and Ellis eventually sent one of its staff members to Nashville, Tenn., with him for a training program, so that now they can do their own training.
It comes down to walking in the shoes of people who have little in the way of resources and understanding that their frequent lack of dependability comes not from perversity but from having to deal every day with crises of the moment, crises that middle-class people are often protected from, like the electricity being cut off, like missing a bus, like having two little kids and no babysitter.
In those circumstances, a toothache often has to wait. And by wait, I mean wait.
The dental clinic at Ellis Health Center (the old St. Clare’s) does an average of 15 full-mouth extractions a week, a full-mouth extraction being the pulling out of all of one’s teeth. And many of the patients are only in their 20s.
Jumping Jehoshaphat! you might say. But I visited the clinic, and the administrator of it, Cassandra Andriano, assured me it’s true. It made my jaw ache just to think of it.
Most of the patients never had any dental care in their lives until coming into the clinic, I was told. So, yes, there are people in your community whose lives are very different from yours, if you are middle-class, and you shouldn’t be surprised if their reactions to life’s offerings are also different.
The new and bigger Ellis now has two emergency rooms, one at the main hospital on Nott Street, one at the former St. Clare’s location, and I was surprised to learn that between the two they get 85,000 visits a year. Amazing, I thought. The population of the city is only 66,000. The population of the county is only 154,000. Surely most people don’t go to an emergency room at all in the course of a year. Does that mean that some people go all the time, just for minor complaints? That’s what I always hear about poor people, especially poor people with no insurance.
Donna Evans, spokeswoman for the hospital, said there is certainly some of that, but she said 60 percent of the cases are genuinely life-threatening and some unspecified portion of the remainder are serious enough to warrant emergency attention. That still leaves thousands of minor routine complaints that wind up getting expensive emergency treatment.
The new Ellis, through what it calls its Medical Home, tries to deal with the whole person who comes to its doorstep, not just the physically sick aspect of the person, said Kellie Valenti, hospital vice president. A “navigator” will take the person in hand and often discover needs beyond the medical and be able to direct the person to food stamps, to help with housing, or to mental health services.
I was told of one woman who needed dental work but was crying because it was the Christmas season, and she didn’t have toys for her children.
Sacoccio, who over the years has transformed the City Mission from a flophouse into a full social-service agency that is a major player in the rejuvenation of downtown, said he is enthusiastic enough about the idea of bridging the gap between the poor and the middle class that he plans to dedicate the rest of his career to it, and I wish him the best with it.
Poor people have to learn to adjust to the more successful middle-class patterns of behavior, but middle-class people, especially professionals like health-care providers, have to understand that poor people are not just contrary, they are guided by their own experiences.