A new hope

When Jerome Edwards turned 70, he was diagnosed with HIV and AIDS.

“I’d lived a relatively good life,” he said. “I’d been married for 25 years until my late wife died. I was somewhat calm and fatalistic about it.”

Edwards’ nurse practitioner was less calm. “She was shaking,” he recalled. “She said, ’There’s this organization called Hopes that you need to see.’ I’d never heard of Hopes. … It was the best kept secret in town if I may say so.”

Now, eight years later, Edwards is going on 79 and still at Hopes—officially Northern Nevada Hopes—as both a patient and the current Board Secretary. But the clinic is no longer the secret it once was.

Founded in 1997, Hopes opened its doors near the corner of Ralston and Fifth streets for a small group of HIV and AIDS patients, growing its base in tandem with community need, taking over an adjacent building, and eventually adding mobile units to accommodate its growth. Last year, Hopes broke ground on a 37,500-square-feet facility next to its old address, and next week it will welcome the public at its grand opening on March 15.

In the process of going public with the new building, Hopes has expanded its services from existing programming like ChangePoint syringe exchange, HIV-AIDS treatment, and senior outreach, to primary care options like behavioral health therapy, pediatric services, and an on-site pharmacy. The move will also make it possible to more than double Hopes’ patient base from 4,700 to 10,000 individuals.

“Housing means health,” said Sharon Chamberlain, the CEO of Hopes. “Access to care means health. Having food is related to health. Having childcare so you can make it to appointments is a part of health.”

As someone who has struggled with both homelessness and drug addiction in the past, Chamberlain has an understanding of the issues that face Hopes patients—a cross-section of the community that the clinic dubs “underserved.” Seniors, LGBT individuals, uninsured and undocumented immigrants, substance users, the homeless—all are people that traditionally experience more barriers to health care than other populations.

Perhaps this is why every program at Hopes begins with the premise of meeting people where they are.

“If you come here and your diabetes is out of control, but your major concern when you walk in the door is that you haven’t eaten in two days, and you need something to eat, we’re going to help you find food,” said Chamberlain. “We’ll take care of that part first. And once you’re not hungry, if you want to talk about your diabetes, we’ll talk about your diabetes.”

Once a patient’s basic needs are met, the clinic can begin to address the longer-term issues that can make or break a community—issues like ongoing care for individuals and city-wide population health.

Reka Danko, Hopes’ chief medical officer, believes that the key to lasting individual health is building a partnership with her patients to meet goals.

“Whether it’s a medical goal, a behavioral health goal, a housing goal, getting food—whatever it is we can help with, we’re here to listen,” said Danko. “The biggest part of what we do is, without judgment, move forward to help that person in whatever line of care it is.”

For senior patients like mother-daughter pair Marie Hutchinson and Cindy Higgins, their partnership starts with personal attention.

“We were seeing another doctor, and we were unhappy with the service we were getting,” said Higgins. “She would talk to my mom or to me and she never really said anything. I’ve had three heart attacks now, and after the first two, she never really addressed these issues.”

After switching to Hopes, Higgins has been able to keep up with her medications and lose the weight she needed to lose. Hutchinson, a former nurse, will be 102 years old in November (something no medical provider can take all the credit for).

For other patients, like Kristen Aaquist, primary care is specialized care from the onset. As a transgender woman who has undergone transition, Aaquist has hormone and emotional health protocols that some traditional providers aren’t always aware of.

“If you’re trying to approach a new doctor, and you want them to just treat you, you may not want to go through that extra step of educating your doctor about your needs—that’s something the trans community has experienced a lot of.” said Aaquist. “[Hopes is] pretty well educated in what the trans community needs.”

No matter what community individuals come from, all patients receive comprehensive care that includes a case manager, a behavioral health therapist, a psychiatrist, and medical providers. Though integrated facilities are nothing new, it’s a progressive choice for those on the fringe of traditional healthcare, especially those who do not have the time or resources to travel back and forth between primary care providers and specialists.

It may follow that if you have healthy people, then you have a healthy city. But, as Chamberlain alluded, health is more than the medical. It’s more than individual lab results, and it’s more than individuals, too. When tracking health on a broader scale, many facilities apply a “Triple Aim” framework—a term Danko defines as “quality care for the individual, in combination with population health, in combination with a cost effective strategy.”

Within a population, certain subsets of the group will follow different health trends depending on both clinical factors like disease and non-clinical factors like education or socioeconomic status.

For populations who choose not to access care because of cultural barriers—like the fear of getting arrested or deported for drug-addiction and uninsured-undocumented immigrant populations—education is the best medicine, even if it takes years to bring everybody in.

“It’s just taking time for individuals to be comfortable with the fact that they can come into a place and get free syringes and not be put on a list and not be followed by law enforcement officers,” explained Robert Harding, the Harm Reduction & Outreach Coordinator for Hopes’ ChangePoint syringe service program.

For populations where payment is a barrier, Hopes has different options like Medicare, Medicaid, private insurance, and some special exceptions.

“For the people that don’t have insurance, we have a sliding fee scale based on income,” said Chamberlain. “That slide goes all the way down to $10 for a medical visit, which is very affordable.”

On a city-wide scale, Hopes is able to have an immediate impact on problems like infectious disease outbreaks by working with community partners like Renown, St. Mary’s, and the Community Health Alliance to keep sick people, who could get care in a clinic setting, out of the emergency room.

And they’re starting a garden.

Although they won’t be able to grow enough food to move the meter on population health, patients are already looking forward to the 400-square-feet plot and the prescriptions that doctors will be able to write for families to eat from it. Of course, patients will also get to do some gardening, or as Edwards puts it, “take control of a situation, see things develop, and you know.”