H4 currently operates a satellite walk-in clinic in Kaneohe, serving the Windward side of Oahu from Hauula to Waimanalo. This clinic is located in the Kaneohe Civic Center, conveniently in the same building as the State office offering assistance in enrollment for various assistance programs. This clinic is staffed by a physician or APRN supported by a medical assistant and/or care coordinator. The clinic offers the services normally provided by a primary care physician practice, including:
Treatment for mental illness and substance abuse is also provided, either directly or through referral. In addition, due to geographic dispersion of the homeless population along the Windward coast as well as cultural barriers, many homeless individuals needing medical care are unable or unwilling to come to the Kaneohe clinic. To meet the needs of this population, H4 operates a street medicine program. An APRN with special training in street medicine travels to known homeless encampments, accompanied by an outreach specialist and medical assistant. The provider is able to prescribe medications and record in H4’s electronic medical records system remotely from the site of care.
In the spring of 2021, H4 will open an interim medical clinic in the Punawai Building, located at 431 Kuwili Street on the far outskirts of Chinatown. This clinic will use two rooms on the medical respite floor to deliver primary care services while H4 builds out the second floor of this building as the permanent quarters for the Punawai Clinic.
The interim clinic will be open to the public from 10:00 a.m. to 6:00 p.m., seven days a week, and will be staffed by either a physician or APRN, an RN, and at least one medical assistant. Until the interim clinic opens, H4 offers street medicine using a van parked outside the Punawai Building for treating clients of the Punawai Rest Stop who are in need of medical care. The street medicine team consists of an medical assistant onsite supplemented by a physician or APRN providing telemedicine.
The Punawai Clinic is expected to open in its permanent location, with expanded hours of operation, in summer 2021. The final layout will have six fully-enclosed exam rooms plus expanded space for ancillary services, patient counseling, waiting area for patients, and office space for H4’s clinical as well as administrative staff.
H4’s medical respite service, which opened in February 2021 provides 24-hour residence with meal service for homeless individuals who are too ill or frail to recover from an acute illness or injury on the streets but are not sick enough to meet inpatient level of care criteria for a hospital or nursing facility. Medical respite provides a clean and safe environment for a few days to a few weeks, with medical and social service support, for patients in recovery or receiving near-death hospice care. The maximum stay is 60 days.
The majority of patients are referred from a hospital after being discharged from an inpatient stay, outpatient surgery, or treatment in the emergency room. But some patients are referred by other homeless service agencies or by the staff of the Punawai Rest Stop.
The respite floor has 20 fully furnished patient rooms plus communal space that includes a fully-equipped kitchen, dining area, and laundry. With select double occupancy, up to 29 patients can be accommodated. However, two of the patient rooms will be used to house H4’s interim medical clinic for several months, until the permanent space for the Punawai Clinic becomes available in summer 2021.
Staffing on the medical respite unit includes an RN plus at least two care coordinators or medical assistants on duty at all times. In addition, an H4 provider (physician or APRN) will make rounds on the floor each day to monitor patients’ condition and adherence to care their care plan, and a provider will remain available onsite or on-call 24/7 to deal with patients requiring an urgent medical response.
Onsite social services are provided at each of our sites through a partnering organization or directly by H4 staff. This includes case management, outreach, Medicaid application and referrals for housing, employment, and other benefits. H4 also assists in arranging specialty providers, including advanced wound care, outpatient surgery, and HIV testing and counseling. H4 also provides mail service at its Kaneohe satellite clinic, since this service is not otherwise available in Windward Oahu. Mail service is provided by the first-floor Punawai Rest Stop to support H4’s patients in the Punawai Building.
To the extent that patients are willing, every medical respite patient is assigned a case manager to help orient them to the procedures and rules of the unit and to assess their underlying needs around mental health, addiction, medical care, income, education and readiness for permanent housing upon discharge. In many cases, this case management service carries over from the patient’s treatment in a hospital or by other homeless providers including Mental Health Kokua operating the Punawai Rest Stop. Patients with existing case managers from partner organizations may continue with them.
The Hawaii Homeless Healthcare Hui, or H4, was formed as a public/private partnership, supported by a variety of heath care and social service professionals and philanthropists, to create a new model for meeting the healthcare needs of Hawaii’s chronic homeless population.
H4 was founded by two dedicated physicians with extensive experience in responding to the healthcare needs of the homeless:
H4 was established as a 501(c)3 organization in October of 2017, and we immediately began working with the City and County to identify a suitable facility to house comprehensive service for the homeless. (See the HOME tab for the four-level model of care for the homeless envisioned by the City.)
In February of 2019, H4 was approved by the Department of Community Services and the City Council to provide clinic and medical respite services at what is now known as the Punawai Building, 431 Kuwili Street in Iwilei. However, the building required major renovations, which were completed in December 2020. During the intervening period dominated by the COVID-19 pandemic, H4 undertook several initiatives to serve the homeless of urban Honolulu on an interim basis:
- In early 2018, H4 began clinic operations at two interim locations in urban Honolulu: The Institute for Human Services’ Men’s Shelter in Kalihi and the Chinatown Joint Outreach Center adjacent to the police substation in Chinatown. These clinics operated for more than a year but ultimately had to close due to COVID-19.
- As the COVID crisis emerged in 2020, H4 was asked to provide clinical staffing for the Temporary Quarantine and Isolation Center operated by the State Department of Health. This facility in the Iwilei area was designed to provide a place for homeless patients to be housed and receive medical care when they test positive for COVID or receive a COVID test and are awaiting the results.
- From August 2020 through the end of the year, H4 furnished a provider (physician or APRN) for the Aloha Free Clinic in Kalihi, which provided free primary care targeted towards those who had lost their job and health insurance due to the pandemic. H4 also provided physician consultations via telehealth for IHS’s Sumner Street Clinic during this period.
As the City completed its renovation of the Punawai Building at the end of 2020, H4 was able to turn its attention to developing and implementing our original vision of providing comprehensive healthcare and supporting social services for the homeless at this single location.
Founding Donor Organizations
H4 is grateful for the substantial capital funding and in-kind donations provided by HMSA, Islands Hospice, and the Queen’s Health System, which helped launch our non-profit organization in late 2017. The funding assistance of these organizations has also supported operating our interim clinics, building out the second floor of the Punawai Building to house our permanent full-service clinic, and beginning operation of our medical respite service at Punawai.
Other Funding Organizations
H4 is also grateful to the nine organizations that have supported H4 by providing financial assistance through a formal grant program, special donation to support the development of our Kaneohe Joint Outreach Center, or by providing building space and subsidized utility costs.
Other Supporting organizations
Finally, H4 is grateful for the assistance of 12 other healthcare and volunteer organizations that provided free/discounted services or whose staff provided direct services to patients in partnership with H4.