Street medicine team provides care to Long Island's homeless

For the last few weeks, Ginny Collins, 66, and her two small dogs had been living out of her compact SUV strapped with storage bags and outdoor equipment. Parked in a quiet lot off a main road in central Suffolk County on a recent morning, nurse practitioner Jen Stevens and a team of medical professionals came by to give her a checkup.

How's she feeling? Are her medications giving her side effects? Is she drinking enough to stave off dehydration in the steamy weather?

Collins, who said she's been unable to work since she suffered a stroke about a year ago, told Stevens that lately she's felt dizzy and had headaches. She has a history of blood clots and is in need of knee replacement surgery. The stress of being on guard during the night has also impacted her health.

"It’s very taxing on me," she said. "This is not the life for anyone."

Stevens is a volunteer with a street medicine team that heads out twice a week to check in with homeless people throughout Nassau and Suffolk. Through a partnership with the Long Island Coalition for the Homeless, a rotating group of Northwell Health doctors, nurses and other clinicians travel with outreach workers and provide care to people who may be living in an encampment in the woods or crashing on a friend’s couch temporarily. Some, like Collins, are living in their cars.

About 10,000 Long Islanders experience homelessness every year, according to the Coalition, which conducts an annual count.

That count estimates on any given day, 4,540 people on Long Island are homeless. Almost all of them are living in emergency or transitional housing. About 320 of them are unsheltered, meaning they could be living in a car or outside. 

Coalition staff identifies clients that have health issues or need a medical exam for housing applications.

Dr. Debbie Salas-Lopez, executive vice president for Northwell’s Institute for Community Health and Wellness, started the Street Medicine Program in May 2024. She had run a similar program while working in Pennsylvania.

"They are not a 'seen' community," Salas-Lopez said during an interview in her New Hyde Park office. "Working with the Coalition helped us understand how important it is to approach people with respect and dignity and not make assumptions of what they need ... Sometimes they need a bottle of water or a fresh pair of socks or someone to talk to."

So far, the Street Medicine Program has gone into 49 communities and met with 84 patients 205 times. In 11 cases, clients have needed immediate help that required a hospital visit, including a person who needed a pacemaker. Salas-Lopez said the program currently has a $200,000 budget. Northwell staff volunteer their time to join the team.

For the most part, clients receive help and referrals for managing chronic conditions such as high blood pressure and diabetes. Psychiatric nurse practitioners conduct evaluations and connect people with counseling. The clients may have Medicare and Medicaid benefits, but aren’t sure how to access the health care they need. 

At Collins' car, Stevens and the team — nurse practitioner Mary Mahoney, registered nurse Kristine Black and Dylan Schwarz, the Coalition's street medicine liaison — mix friendly banter and fussing over Collins’ dogs Vivian and Kida with serious questions about her safety and health. After checking her blood pressure and blood oxygen level, Stevens gave Collins a quick neurological exam and determined she needed to see a neurologist. Collins also needed to have a blood test to see if the increased dose of lithium she takes for psychological issues could be causing the dizziness.

"We always go through their medications to see what they're on, look for drug interactions and make sure they're taking their medications properly," Mahoney said. "A lot of times they get confused and they're not taking them properly."

A former veterinary technician and dog trainer, Collins said she has family on Long Island but they don't help. She gets by with showering at a gym. Schwarz and other staff at the Coalition are trying to get her Medicaid and Medicare benefits transferred from Florida, where she had been living before traveling north.

Collins' car is packed with blankets, containers of dog food and other necessities — including a large kitchen knife she has brandished to ward off late night intruders. "I’m not a fool," she told a reporter. She and Coalition members asked that her precise location not be published.

Skyrocketing rent

Homelessness has been present on Long Island for decades. The lack of affordable housing and vouchers to help low-income people pay for rent has only made the situation worse, said Greta Guarton, executive director of the Long Island Coalition for the Homeless.

"Really ever since [the COVID-19 pandemic], the cost of rental housing has skyrocketed," she said.

The average asking rent for a one-bedroom apartment on Long Island is $2,637, according to commercial real estate data and analytics company CoStar, which owns Apartments.com. That includes professionally managed buildings with five units or more, but not developments made up of entirely affordable units and senior housing.

Many apartments don't allow pets — a nonstarter for many people. 

Some affordable housing is set aside for people with disabilities, but applicants need medical records showing they meet the requirements. The Street Medicine team has been able to provide evaluations to some of those eligible clients, she said.

"We do a lot of survival work with folks on the street, but our ultimate goal is helping them get into permanent housing," Guarton said.

After Collins in central Suffolk, the team traveled to another parking lot, this time in Huntington, to check in with another client — a well-dressed 63-  year-old woman, who asked not to be identified because most people don't know she is homeless and she is looking for work.

"You would never know she is homeless — she looks like a PTA mom," Mahoney said, pointing out many clients don't fit the stereotype of a homeless person living on the street.

She has also lived in her car off and on, but for the next two weeks is staying with a friend.

The woman said she cut short a career in information technology to take care of her elderly parents years ago. After they died, she ran through her savings and retirement funds and is having a hard time finding a job while trying to figure out where to stay.

The team asks about her respiratory issues and high blood pressure. Along with health issues, they talk about connecting her with a job center to update her resume. As with the other clients, they leave her with a bag of toiletries, water and other essentials.

"It’s really nice that they come to meet you where you’re at," she said. "It’s hard to get doctor’s appointments so the instant feedback and evaluation is really helpful."

Not a good place

The team drove to the Freeport Library to meet with Richard Seibert at one of the outdoor tables.

Five months sober, the 65-year-old looks healthy and refreshed as Stevens checked his blood pressure and reviewed his health chart. They discussed management of his diabetes, high blood pressure and arthritis. He received a referral to a liver specialist to determine if he has liver disease.

A self-proclaimed "bay rat," Seibert grew up in Freeport on the Great South Bay boating and fishing. A divorce, losing his home and alcohol addiction led to him being homeless, he said.

"I was outdoors for quite a while," Seibert said. "And once you are outside, it’s hard to get the momentum ... you need somebody to come in and help you."

His case workers at the Coalition for the Homeless helped connect him with an apartment in Hempstead but they are waiting on some paperwork before he can move in.

"Where I am right now is not a good place," Seibert said of his current living arrangements, though he didn't want to get into details.

"I’m looking forward to getting back to a normal life," he said.