On Friday morning, four members of the Street Nursing Program at Adventist Health/Rideout Hospital in Marysville received notice that their positions would be eliminated.
“After careful deliberation, we are faced with the difficult decision to eliminate your position at Adventist Health and Rideout Hospital, effective 04/15/2024. However, as of 04/12/2024 you will no longer be required to report to work. You will continue to receive pay for any of your regular scheduled shifts through 4/12/24,” a document titled “Re: Notice of Permanent Layoff” stated that was given to at least one member of the Street Nursing Program on Friday. “... Please return all of Adventist Health property, including identification cards or badges, access codes or devices, keys, laptops, computers, telephones, mobile phones, hand-held electronic devices, credit cards, electronically stored documents or files, physical files and any other Adventist Health property or information in your possession.”
Since its founding about five years ago, the Street Nursing Program has provided valuable outreach services to the homeless population in Yuba-Sutter. Not only do its members provide basic levels of care, but over time, they have come to be a source of inspiration and communication that other similar services in the area have been unable to fully provide, according to those who worked for the program.
Chris Champlin, president of Adventist Health/Rideout, told the Appeal that the elimination of the program at the hospital should be considered a transition, that the services provided by the hospital were redundant because area clinics and other providers could offer the same assistance to those who need it most.
“We are transitioning out the Street Nursing Program to a combination of Ampla Health, Peach Tree Health, and Harmony Health,” Champlin said. “We’re working with our county partners and our FQHCs (Federally Qualified Health Centers) to transition the patients that were in our care to their programs. … The hospital offering this service was a redundancy.”
Champlin stressed that the decision to cut the Street Nursing Program was not solely due to costs. However, in a press release issued by the hospital on Monday afternoon, finances were front and center.
“As we navigate the same budgetary challenges that many healthcare organizations are facing across the nation this year, Adventist Health and Rideout has made the difficult decision to close its Street Nursing Program,” the release states. “This decision was not made lightly, but after careful consideration, we believe it's necessary to focus resources on our core services. Our aim is to ensure that we can continue to meet the needs of our community and fulfill our mission in the most impactful way possible.”
Those closest to the program, including a former member and co-founder Cindy Cooper, suggested grant money and other forms of financial support were available to help offset costs.
“The street program was grant funded,” Cooper told the Appeal. “It started with grants. We’ve been working off grants since we started the program. There’s still money available to support the program.”
Champlin said at one point in time the Street Nursing Program was grant funded. He referred to it as a “minor subsidy,” but over the years he said those grants have largely expired.
“It's important to note that when the Street Nursing Program began in 2019, financial support from health plans was virtually non-existent, and we were the sole provider serving this vulnerable population,” the hospital said in a statement. “However, the landscape has evolved since then. Today, there is financial backing from various community healthcare partners, including the introduction of Partnership launched in 2024 and CalAim reimbursement.”
Medical care costs in the country have skyrocketed in recent years and Adventist Health, much like other entities, has had to adjust for that.
“Costs have gone up overall,” Champlin said. “We raised the nursing salaries to be competitive with Sacramento and the Roseville area so we could keep our nurses. Because of that our nursing turnover ratio is the lowest in all of Adventist Health. We are looking at salaries again this year.”
Since news that the elimination of the Street Nursing Program got out, several close to the program have speculated and worried about what may come next, if anything at all. Champlin assured the public that this was merely a transition, not an elimination, of services.
“Our intent is to keep the program going, to serve the homeless population through the FQHCs and the mobile clinics,” Champlin said. “... This is about transitioning. There are organizations that are specifically set up to do this.”
For Champlin and the former members of the street team, maintaining established relationships is key. That is why he and the hospital said they are making efforts to ensure that the four members who were let go are rehired by the FQHCs to continue their work.
“We’re working with our county partners and our FQHCs to transition the patients that were in our care to their programs,” Champlin said. “... It is important to have our staff within these organizations. … One of my conversations with a FQHC, said, ‘I will hire their team, I will put them on a street team,’ and through the grave vine, one of the other FQHCs said something similar. They will have our nurses run their street nursing team. Not only is there continuity of care, but relationships that have been built will continue.”
One hospital official, who wished to remain anonymous, said some members of the Street Nursing Program have already been contacted or connected with another provider.
“I reached out to the team. I expressed that I know they weren’t happy with the decision,” the person said. “I was going to create introductions and I gave them contacts yesterday (Sunday). There’s a process everyone needs to go through. They were aware that we were facilitating those introductions. The secondary FQHC has been distributed. Yesterday, an individual's cell (number) was passed along, and then another individual was given information.”
Along with the end of the Street Nursing Program, Champlin also said its food pantry that was run via the program will also stop. Much like the services the street program provided, Champlin said the pantry also was redundant because of other community services such as the Yuba-Sutter Food Bank.
“We do have a food pantry, but it will not continue,” Champlin said. “We will be dispersing everything we have, including sleeping bags and tents. We are working with stakeholders.”
One of those stakeholders is the Sutter Yuba Homeless Consortium. Executive Director Johnny Burke said Monday that work was already underway behind the scenes to make sure the street team could still exist in some capacity and that all related entities in the area were knowledgeable of the situation and what needed to be done.
“This work is going to continue. We’re all in discussions right now,” Burke said.
While Champlin did not want to get into the specifics for what the Street Nursing Program actually cost the hospital, he did say that the services it ultimately provided were not part of the original mission.
“Our nurses may have been doing what they considered above and beyond, but the program is designed to deliver critical care to the homeless,” Champlin said when asked if other health clinics can provide the direct care and communication that the street team provided. “The nursing program is intended to deliver care. When we look at what we should be doing and what this evolved into, there’s a discrepancy.”
Even though Champlin said he would like other clinics and healthcare providers to offer the same level of care as the Street Nursing Program ultimately did, he said that was largely up to those specific providers.
“They may not run them like we allowed them to run,” Champlin said. “The services are not being cut, they are simply being transferred. Will the others run like we did? That’s for them to decide.”
Rachel Farrell, CEO of Harmony Health, confirmed with the Appeal that her clinic would try to include the street program in the services already offered through Harmony Health.
“I told him (Champlin) I’d absorb that program since we have a clinic on wheels and our mission is to serve the underserved,” Farrell said in an email.
Currently, the services offered by entities such as Harmony Health typically revolve around mobile health clinics. However, members of the street team said in order to reach those who truly need the most help, mobile clinics at a central location are just not enough.
“Counties and health clinics are not providing the same services as the street team,” Cooper said. “They have mobile clinics that they expect people to come to. The street program goes to where the people are. There are a number of reasons to bring care to them and not them to you – it’s a model that doesn’t work. … They don’t go down to the river bottoms and change wounds.”
Cooper, who was previously homeless as a teen, has been a nurse for about 33 years, 16 of which were with the hospital in Marysville. She said she started the Street Nursing Program about five years ago with Ashton Phillips.
“We built the program from there,” Cooper, who is now retired, said. “ We went out into the streets to find out what they (the homeless) need and tailored those services to their needs. … The reason we started this program is because we had such an influx of homeless people using emergency care.”
Cooper said from July 2023 to April 2024 there were 864 interactions that the team had with homeless individuals in the area. Those interactions typically led to other services or communications that went beyond what Champlin said was the original intent of the program.
“It took a while to build this program, to build trust,” Cooper said. “The staff wants to have the program continue, they don’t care who manages it.”
As noted in the news release sent by the hospital, phones had to be returned among the other items the street team may have possessed. Because the team was only notified on Friday that they would no longer be able to do the work they had done, some patients were and are now left in the dark.
“They saw a patient Friday that had a pacemaker,” Cooper said. “The nurses were supposed to follow up with her, help translate, and support her. They were supposed to be there at 10 o’clock today (Monday).”
Counties respond
In the transition away from the hospital and to area clinics, Champlin said the counties have been kept in the loop about what is happening – mostly because they are the ones who contract and work with clinics such as Ampla Health, Peach Tree Health, and Harmony Health. They also have behavioral health and other services that directly benefit the underserved population.
For example, he said Yuba County has a contract with Peach Tree Health to “serve as the county’s clinics. In that respect we’ve been working with them.”
Sarah Eberhardt-Rios, director of Sutter County’s Health and Human Services (HHS), said the county does not have any street nursing programs, but does work closely with services that do help homeless individuals.
“We work very closely with street nursing programs in the delivery of our homeless services, to include working with local FQHC's and Adventist Health and Rideout (AHRO). A large percentage of folks who are unhoused in our local community have Medi-Cal for their health insurance coverage,” Eberhardt-Rios said in an email to the Appeal. “Street nursing and other medical services reimbursable under Medi-Cal are paid by Medi-Cal Managed Care Plans in California. Partnership HealthPlan is the Medi-Cal Managed Care Plan for those folks in Sutter County that are unhoused and have Medi-Cal. Through CalAIM, a statewide transformation of the services available under Medi-Cal has been underway for the last two years. Sutter County HHS, along with our health care partners to include AHRO, the FQHC's and the Sutter Yuba Homeless Consortium (SYHC) has been highly engaged with the Medi-Cal Managed Care Plans to ensure that services that best support those who are unhoused, are rolled out locally in our community. This background is important to share as it takes a network of providers working together to best deliver the services under Medi-Cal, to include all the new services available under CalAIM, many of which are designed to better address the needs of those who are unhoused.”
Jennifer Vasquez, director of Yuba County’s Health and Human Services, also confirmed that Yuba County does not have a street nursing program. She said the county does not expect any impact on its services as a result of the hospital ending its program.
“The street nursing program has always been independently operated by the hospital however, individuals involved in our housing programs do utilize the street nursing services,” Vasquez said in an email. “We are fortunate to have excellent FQHCs in this community and anticipate the transition will have positive impacts as new opportunities with CalAIM continue to expand.”
The team
Aundrea Caracciola was the lone nurse in the Adventist program after Cooper retired. There were four members on the team: a nurse, social worker, dietician and housing navigator.
Caracciola said there was no prior notice that all four would lose their jobs on Friday.
“We went into work, we knew we had a follow-up HR appointment at 9 a.m. We thought it was to follow-up with another issue that we had talked to HR about,” Caracciola said. “We came into work thinking we were working. Went to the meeting and they told us that effective immediately our program no longer existed, and that we were to go to our offices and clear out our things and leave.”
Caracciola also confirmed that their cell phones were turned in, which was their main line of communication with their clients.
The former Adventist nurse challenged the idea that her position and others on the team were redundant – asserting that what they offered simply wasn’t being currently offered in full by other providers.
“Totally not the same as what we do,” Caracciola said. “... Our interest is to continue street medicine because what street medicine means is we go to the people. We’re not parking in a van somewhere and asking people from the river bottoms to come to us because that’s a barrier in care. … I think there’s a lack of education on the part of Adventist Health/Rideout in what we do.”
Not only were members of the Street Nursing Program providing basic care, but they also helped guide individuals through different processes involved with receiving proper care through the current American healthcare system – something that can pose a challenge even with working individuals who don’t have to worry about their next meal or a roof over their head at night.
“It’s so much more than just street medicine … also attending some of these appointments and advocating for specialty services that they would not be able to advocate for themselves, or getting there to those appointments,” Alexis Rickards, a social worker who was in the program, said. “It’s even more than just what we do on the street, but what we’re bringing off of the street into medical to keep them out of the hospital setting.”
Caracciola said her team also worked closely at the hospital with doctors and staff to plan for safe discharges, coordinate care, and make sure follow-up appointments were kept.
“Even just to bring a voice to the people that they don’t know, we know them. We see them every day on the streets, so we could always offer assistance in just knowing their background,” Caracciola said. “We’ve reunited families with a person that was dying in ICU that they hadn’t seen in seven years. You know those are services that Ampla, Peach Tree, and Harmony Health might not be able to offer. It’s not the same. There was no transfer in care. We abandoned over 860 patients that we were actively working with since July of last year.”
Along with a disagreement over what the hospital described as redundant when it came to the street team’s actions, they too said the food pantry was not a redundant service. While the Yuba-Sutter Food Bank may be able to provide and distribute food to those in need, it wasn’t meeting the people where they were, such as in the river bottoms.
“They did not meet people where they are at. They are starving. They are asking for food,” Rickards said.
Caracciola said the dietician would go to the food bank to get food and along with meals provided by a grant, she would get food directly to those who needed it. Caracciola said there was “absolutely not another community service that does that for the homeless population” except for those that may provide meals at parks or other locations on a routine basis.
Both Caracciola and Rickards said on Monday they had yet to be contacted by any other area healthcare provider to possibly continue the care the Street Nursing Program was able to provide.
The pair also suggested that funding for the program was largely paid for by grants.
“We have only ever been told that it is almost completely grant funded,” Rickards said.
Caracciola said “it is a billable service” now through options such as Medi-Cal, but Champlin said “nurses cannot bill for their time.”
Rickards also claimed that some funding that had been “granted” to the Street Nursing Program will now have to be “given back.” She said the hospital was “offered several hundreds of thousands of dollars to keep the program going.”
Both Caracciola and Rickards said they loved what they were able to do as part of the program.
“This was the job for me. I was made to do this job, especially in the community I grew up in,” Caracciola said. “... I want to do street medicine.”
The pair said the elimination of the Street Nursing Program is a huge loss. Along with possibly increasing the amount of people in the emergency department, others may simply die or become more sick because that direct care is no longer available to them.
“We played a huge role of keeping those people out of the ER,” Rickards said.
The unhoused
On Monday at the Life Building Center in Marysville – a coordinated entry site for the homeless, the Appeal spoke with some of the individuals the street team has previously helped.
Several of those that the Appeal spoke with felt frustration over the sudden closing of the program and what that would mean moving forward. Most were concerned that the same level of attention and care the program was able to provide, just wouldn’t be possible with any other provider.
“I have an appointment with a primary (care provider) in May … I’ve been getting a lot of help from them (Street Nursing Program),” Lynn Thompson, who said she’s been homeless in the area for more than eight months, told the Appeal. “Other than therapy – someone to vent to, they’ve been pretty kind to me – I get my regular prescription of ibuprofens from them. It’s important to me because now I don’t know where I’m gonna get them and now I’m out.”
Thompson said information about mobile health clinics is largely unknown to some in the homeless population unless they happen to be at a site such as the Life Building Center, stressing the need for people such as those in the Street Nursing Program to go out and speak to individuals where they are at, rather than where others would hope them to be.
Amya Malloy said she’s been homeless in the area for about a month. Pointing to both Caracciola and Rickards, she said they helped her get to Gridley for an appointment. When thinking of what the Street Nursing Program was able to provide for her, Malloy became emotional.
“They helped me a lot,” Malloy said. “I have high blood pressure. I could have died, but they took me. They looked out for me and were really good to me. People need them, in this county, they need them. It’s not fair.”
Malloy said going through the otherwise proper channels for healthcare was just too much.
“I’ve been pushed from place to place because I don’t have this, I don’t have that. They helped a lot,” Malloy said.
Chandra Johnson said she’s been homeless for about three years and has interacted with the Adventist street team the entire time. She said they were able to connect her with medication and supplies that she needed.
“I came from Sacramento, so it was harder getting my medicals switched. After six months, it wasn’t being switched, so I wasn’t able to go anywhere, see anybody,” Johnson said. “I was able to see them on Tuesday, to where I had sprained my leg, and they were able to give me a bandage or a wrap and get my swelling down.”
Johnson said the advantage of having the street team available is that they were just that, available.
“I wasn’t able to be seen anywhere. … I was able to stay here (Life Building Center) and actually see them when they came in,” Johnson said.
Gina Jones, who was previously homeless, said she is now housed thanks to the Street Nursing Program.
“The reason I am housed is because of the street team,” Jones said. “They found me at the river bottoms when I first became homeless, at least four years ago. I was really sick. I had a hernia and I couldn’t get up. They found me and they called the ambulance for me and when I got out they told me to come here (Life Building Center) and I became housed eventually because of the care.”
For people such as Jones, the care and attention demonstrated by the street team was vital.
“She made sure when I was here I was OK, when I was having problems with some employees here, she went and fought for me,” Jones said. “She went to my primary doctor’s appointment, anytime I went to the ER she was there, because she knew I was scared. She’s always been supportive to me, always.”
Jones said if it weren’t for the street team, her and others would be dead.
“It’s gonna be a lot of homeless that die,” Jones said in reaction to news that the program was canceled. “I was one of them. I just laid there, you give up hope, you have no hope. And then she came there and gave me hope, just gave me hope and encouragement to get my surgery and know that everything will be OK. I would have died down there at the river bottom, I know it. … It was bad down there, but she made sure I kept my hope. … I’m housed because someone cared and that’s hard to find when you’re homeless. … They cared enough that where I wanted to care about myself and do better. … I couldn’t survive out there anymore, it was too rough.”
