"I didn't like poking my finger," Louie Aquasanta tells me. "I wasn't testing my sugar."
The 59-year-old Schenectady resident is discussing his diabetes with a nurse named Molly McTernan.
In the past, Aquasanta's day-to-day management of his disease suffered because he was reluctant to check his glucose level.
But in January, he began meeting with McTernan once a week and, with her help, he's been monitoring his blood sugar much more closely. "I prick my finger twice a day," he says. "Once in the morning and once at night."
McTernan isn't employed by a traditional health care provider.
She works for Bethesda House, the State Street non-profit organization that, among other things, runs a homeless shelter and drop-in center for the poor, called the Hospitality Center, and helps low-income people find housing and manage daily life.
McTernan's hiring, in early winter, was significant: It marked Bethesda House's increasing commitment to helping clients manage their physical and mental health.
The hope is that providing the population Bethesda House serves with medical care on site will lead to better health, fewer visits to local emergency rooms and more stability overall.
It's an innovative approach to helping people in need, in large part because it acknowledges that it isn't always enough to give people shelter. If you want people to live independently and take care of themselves, you need to treat whatever's ailing them.
"We're seeing more people with medically complex issues," Louise O'Leary, director of program & case management services for Bethesda House, told me.
Those medically complex issues often included undiagnosed mental illnesses and substance abuse. Addressing these problems can help people stay housed, by making it easier to cope with the demands of daily life.
Which might sound simple enough in theory, but can prove challenging in practice.
Getting Bethesda House clients to open up about their health problems requires building a relationship with them and gaining insight into their circumstances.
McTernan doesn't wait for clients to visit her in her office and ask for help. She does home visits, and also spends a great deal of time at the Hospitality Center, reaching out to people who seem to be struggling with a health problem.
"More often than not, (Bethesda House staff) notice something," McTernan said. "We might see someone limping, or see that something is bothering someone's eyes."
On one of her trips to the Hospitality Center, McTernan noticed that a man's legs were swollen and leaking fluid - "weeping."
"I said, 'Hey, you look uncomfortable,' and asked whether I could put a bandage on him,'" she recalled. "After that first encounter, he really opened up."
The man eventually revealed that he had a prescription for a diuretic to get rid of the fluid that accumulated in his legs, but that he didn't always take it when he was supposed to.
The reason: He was homeless, and the diuretic made him urinate more frequently. "We offered him a spot in our shelter, and we made sure he had access to a bathroom," McTernan said.
McTernan's office, in State Street Presbyterian Church, is directly across the street from Bethesda House.
She isn't the only medical professional based there - a psychiatric nurse practitioner started working out of the office just last week, and doctors from Ellis Hospital see Bethesda House clients there twice a month.
The organization also provides transportation to and from appointments, picks people up from the hospital and brings clients to the pharmacist to get prescriptions.
A new program, launched in January in partnership with St. Peter's Health Partners, provides people on Medicaid who have two or more chronic conditions, a serious mental health illness or HIV/AIDS, with access to care coordinators who help manage their medical care.
"We're educating the population we're working with," explained Leina Minakawa, director of social work at Bethesda House. "We're saying, 'This is going to be good for you.'"
Providing health care services on site increases the likelihood that Bethesda House's clients will go to follow-up appointments, stay connected to a primary care doctor and take their medicine properly, Minakawa said.
If clients need help navigating the health care system or troubleshooting a problem, Bethesda House will step in.
"If someone is having an adverse reaction to their medicine, we can call their provider," Minakawa said. "If someone has a history of alcoholism and they're prescribed meds that shouldn't be taken with alcohol, Molly can say, 'This medication should not be used with alcohol."
"Ultimately, these programs are meant not only to provide services, but to connect people to services," Minakawa said.
Aquasanta is a Bethesda House regular - someone I often see walking around Hamilton Hill with a Yankees cap on his head. He likes telling jokes and stories, and had an easy-going banter with McTernan, who he said had been very helpful to him.
"I try to do back-up for his doctor, to reinforce what she says," McTernan said. "I ask whether he's keeping up with his diabetes. I try to keep him out of the hospital."
Aquasanta landed in the emergency room earlier this year after passing out due to low blood sugar levels and hurting his ankle. McTernan told me she's trying to develop a plan for him that involves eating better.
"I'm not following it," Aquasanta said, with a sly smile. "I'm still eating greasy food."
It was an honest, if slightly disappointing, comment, and it reminded me that getting people to take care of themselves isn't always easy - something the staff at Bethesda House is well aware of.
Aquasanta might not be a perfect patient, but the medical programs at Bethesda House are helping him manage his health better than he once did.
Which is a good thing, because everyone benefits from living in a healthier community.
Reach Sara Foss at [email protected]