Grant brings ‘health coach’ to community center in Holley

By Ginny Kropf, correspondent Published on May 28, 2022 at 7:49 am

The site will establish a telehealth center to help people access health care

Renee Hungerford

HOLLEY — Homeless people and those living in poverty and other challenges will soon have access to free health care, thanks to a grant received by Orleans and Genesee County Community Action.

Renee Hungerford, director of Community Action, announced that her agency received a grant from the Finger Lakes Performing Provider System to fund a program she calls “Axis of Care.”

Hungerford has a health care background with a focus on informatics and the social determinants of health. A few months ago, she learned that FLPPS had funds for innovative programs aimed at bringing health care to the homeless or those at risk of becoming homeless.

She wrote a proposal and submitted it. She came up with the name “Axis of Care”, comparing the meaning of the axis (a point around which things come together) to local agencies that come together to provide “access” to health care.

Community Action knows firsthand the extent of poverty in Orleans County. Last year, Hungerford reported that the East Orleans Community Center in Holley served 6,277 meals to nearly 400 people. Plus, hundreds more received free clothing, pantry services, and holiday gifts and baskets.

At the time Hungerford wrote his proposal, Orleans County had the third-lowest health ranking in New York State, according to “County Health Rankings.” It ranks in the bottom quartile for outcomes and health factors.

There is an increased risk of premature death, as well as much higher than the state average for infant and child mortality. Some of the health-related behavioral problems are smoking, obesity, lack of physical activity, and teenage births.

Much of the area is considered a “food swamp”, in that the food available comes from fast-food restaurants or dollar stores. Public transport is very limited in the county, which creates an additional barrier to health care and nutrition.

Hungerford reported that according to “Homeless Shelters Directory”, in 2019 there were approximately 924 homeless people in Orleans County. The pandemic and the recent end of the eviction moratorium have certainly increased that number, she said.

Other information obtained by Hungerford indicates that medical care is estimated to be only 10-20% of modifiable contributors to a population’s healthy outcomes. She said Orleans County has only one doctor for every 13,540 patients.

In response, Hungerford proposed to FLPPS to make the Holley Center an access point that brings healthcare to clients.

FLPPS issued a press release on May 26 announcing the grant and explaining that the community action will hire a health coach who will connect and coordinate individuals with services, set and track goals and outcomes, improve health literacy among people in need and will coordinate transportation to health facilities as needed. . The health coach will be integrated into the existing case management program and will collaborate with a GCASA peer advocate.

A Telehealth Center will be established in the Eastern Orleans Community Action Community Center where community members experiencing homelessness or at risk of homelessness can access health care using telehealth services. The agency partners with Orleans Community Health, Oak Orchard Health and GCASA on telehealth services, and will have a mobile health van from Oak Orchard Health. The health coach will connect individuals with needed services such as behavioral health treatments and services at the center or at health facilities.


“Patients need a trusted source to find accurate health information, as well as support in coordinating care. This program responds to these challenges by providing the patient with coordinated health and social care. It is truly a community that comes together to make a difference for people who suffer from many challenges. I feel blessed with the support we receive. – Renee Hungerford, Community Outreach Director


A section of the Community Center’s clothing depot will be divided into a telehealth center, where the health coach will work. The health coach will also be able to provide information about other Community Action services, such as bloat, Head Start, utility assistance, and daycare.

Carol Tegas, executive director of FLPPS, said her agency is proud to partner with organizations in the community that have fostered deep trust with individuals and have the expertise to provide excellent services in a model of care. collaborative.

“This pioneering program aims to address health disparities and will provide lifesaving care to vulnerable people in a rural community,” Tegas said.

“Navigating the healthcare system is difficult for everyone and even more so for people who are experiencing life challenges, such as poverty and homelessness,” Hungerford said. “Access to care is hampered by a low number of available healthcare providers, coupled with a lack of transport. Patients need a trusted source to find accurate health information, as well as support in coordinating care. This program responds to these challenges by providing the patient with coordinated health and social care. It is truly a community that comes together to make a difference for people who suffer from many challenges. I feel blessed with the support we receive.

Sean Ossont, President of Continual Care Solutions, said they were delighted to be the technology solution partner in the Axis of Care homelessness initiative.

“Being a common digital platform is necessary to have a holistic view of who will receive supports and services from a network of community providers,” Osson said. “Data capture and visibility of results will provide accurate insights into best practices and impact the initiative.”

Hungerford said they hope the new program will be up and running as soon as they can hire a health coach, hopefully over the summer.

Jill E. Washington