Lee Co. harm-reduction chief says 80% of clients are homeless

Jo Ann Fraley runs the harm-reduction program for
the Kentucky River District Health Department.
(Photos by Stu Johnson, WEKU)

By Stu Johnson, WEKU

Homelessness is a reality in virtually every section of Kentucky. Although often thought of as an urban challenge, rural Kentucky also finds the plight of the unhoused a pressing issue. Here's a glimpse of how one Appalachian community is addressing homelessness needs.

There is a gathering spot inside The Hub in downtown Beattyville. It’s the Lee County Health Department's harm-reduction center, where staff work to connect clients with care providers.

The director is Jo Ann Fraley, a social worker who’s worked in addiction and recovery. Fraley said about 80 percent of The Hub's clients live on the streets or are couch surfing, and many don’t realize their health status.

“Lot of them have blood-pressure issues and they don’t even know. A lot of them have diabetes and they don’t even know,” Fraley said. “So, those issues we need to address as quick as we can.”

Fraley said the focus is getting people hooked up with doctors and health providers, because “We can’t expect change if we don’t help with the changing process.”

“They’ve lost hope. They give up. They’ve burnt every bridge that they have with family. And so, they let themselves go and they just think nobody cares about them. And whenever someone goes somewhere and they’re not treated very nice, they don’t go back,” said Fraley.

Another staff member at The Hub is Shawn Maynard, who was a user of oxycontin, pain pills, and then methamphetamine, along with alcohol. Maynard has been clean for six years and works with clients to address barriers. He said the homeless lifestyle itself creates health risks.

“When you’re homeless, your hygiene’s not gonna be good and that’s gonna create infection, staph infection,” said Maynard. “If you do get a cut and you’re not getting the proper wound care for it, it’s gonna get infected.”

Nathan Tipton

Nathan Tipton, a client of The Hub, said he’s been four months clean after struggling with drugs for years.

“I was on meth and drinking real bad and after my papa and mama died, it got worse and stayed out there in the woods for about four and half year; still homeless, but life makes a big difference when you got God on your side,” said Tipton.

Tipton said it’s different from before, he was stealing and robbing to get a fix.

The Lee County Health Department is part of the Kentucky River Health District. District Health Director Scott Lockard said he and Fraley brainstormed over The Hub concept, and said creating bonding relationships is important.

“We form that relationship. We show them that they can be treated with dignity. We establish trust and then when the timing is right and they’re ready for treatment, we can link them to treatment immediately,” said Lockard.

“Health is the foundation for everything. If you don’t have health, you can’t worry about education, you can’t worry about employment. You can’t worry about everything else.”

So, Lockard said that means linking up to a medical home and making sure the clients have a payer source, which for most is Medicaid. He said some don’t even realize they are eligible for the fedreal-state program that provides free medical care to lower-income people.

Lockard said the district is trying to to establish a similar program in Letcher County, and he envisions similar like services in all seven Kentucky River District counties, ideally in the next five years or so. Besides Lee and Letcher, the district also includes Knott, Perry, Leslie, Owsley and Wolfe counties.

Bill Wagner, who headed group of health clinics for disadvantaged in Louisville, wins Gil Friedell Memorial Health Policy Award

Wagner, left, with Foundation President and CEO Chandler

William Wagner, retired CEO of Family Health Centers of Louisville, is the latest winner of the Foundation for a Healthy Kentucky's Gil Friedell Memorial Health Policy Award, for his work expanding access to care and coverage.

“Bill’s passion for bettering the health of Kentuckians is a perfect reflection of the spirit of the Gil Friedell Memorial Health Policy Award,” said Ben Chandler, the foundation's president and CEO. “Dr. Friedell was a passionate advocate for access to health care. Bill’s 40-year career is a testament to his commitment to serving others by expanding opportunities for health-care coverage and bringing medical care to underserved areas in rural and urban communities. He has made a profound impact on the health and wellness of countless Kentuckians.”

Wagner established primary-care centers focused on people who are low-income, homeless, immigrants and refugees, then expanded them to include dental, behavioral health, pharmacy services, health education, outreach and enrollment services.

He was influential in the evolution of Kentucky’s Medicaid program, helping develop the nonprofit Passport Health Plan for managed care of Medicaid patients and the Children’s Health Insurance Program, providing medical services for hundreds of thousands of children and adults in Kentucky.

He also helped shape the next generation of social workers and public-health professionals through his work with the Kent School of Social Work and the College of Public Health at the University of Louisville.

“It's an honor to receive the award,” Wagner said. “I accept it on behalf of all the health care providers who work so hard to provide medical care access in underserved areas of Kentucky – urban and rural. They’re the real heroes. I have great respect for them and working with them made my job so fulfilling.”

Wagner retired at the end of 2021, something he delayed due to the pandemic. During it, he worked with non-English-speaking communities to provide testing and education. When vaccines rolled out, Wagner was at the forefront, helping with logistics, outreach, and education, most notably with the homeless.

The Memorial Health Policy Award is named for Gil Friedell, first director of the Markey Cancer Center at the University of Kentucky and cofounder of the Kentucky Cancer Registry. He helped launch a nonprofit advocacy education organization in 2005 that later became the Friedell Committee for Health System Transformation. The Foundation created the award when it united with the Friedell Committee in 2018.

Wagner and Friedell worked in the mid-1990s to create a community partnership for breast and cervical cancer screening in Louisville’s West End, which had extremely high death rates from those diseases.

The foundation makes a $5,000 grant to a Kentucky nonprofit working to improve health policy in the commonwealth in honor of the Friedell Award winner. Wagner selected Kentucky Voices for Health, a nonpartisan coalition that amplifies the voices of individuals, families, and communities in the decisions that affect the health and well-being of all Kentuckians.

Wagner said he selected KVH because of his concern that many Kentuckians could lose the Medicaid coverage to which they gained access in the pandemic. “Having health-care coverage is key to having access to medical care and living a healthier life,” he said. “I’m concerned when the emergency measures for expanded Medicaid expire, we will have many folks who aren’t sure how to recertify or apply through Kynect. KVH can help fill those gaps.”

Wagner was selected from the foundation's 2021 Healthy Kentucky Champions, Kentuckians honored for making a difference in the health of their communities or the state. Nominations for the 2022 awards are due by May 20. For more information and to nominate someone, visit Healthy-KY.org.

Beshear projects number of deaths based on compliance rates; plasma from recovered patients helps two critical ones; story tells risks to health workers; what are best materials to make masks?

Slide shown by Beshear at his Friday press conference; he did not say how the numbers were figured.

As news develops in Kentucky about the coronavirus and its covid-19 disease, this item will be updated. Official state guidance is at https://kycovid19.ky.gov.

Gov. Andy Beshear put the need for social distancing to fight covid-19 in stark terms Friday, displaying a chart that said poor compliance with his orders could cost 11,000 Kentuckians their lives. The chart resembled others he has shown, but was the first specific to Kentucky, and he said, "As the days go by I'm going to show you other projections. . . . Your choices could save 11,000 people."

One line on previous charts, but not on Beshear's, is a horizontal marker showing the capacity limits of the health-care system. His orders are designed to flatten the bell-shaped curve that pandemics follow, so the number of cases doesn't exceed the system's capacity. But that also means the restrictions that began in mid-March could last longer, and his projection of 2,000 deaths with strict compliance was for three months.

"If we're going through May, it's working," he said at his daily press conference. "If we have really great success we may be at it a little bit longer." He said that as the curve subsides, restrictions could be relaxed gradually. At another point, he said, "We know we're gonna be at this for weeks or months."

Beshear did not say how his numbers were calculated. The latest projection for Kentucky from the Institute for Health Metrics and Evaluation at the University of Washington says the state's most likely peak for deaths and hospital-bed needs is May 17, with a curve that largely subsides by late June. Its likeliest number of deaths is 821, but like all projections it suffers from limited data; it says the possible number of deaths on the peak day ranges from 1 to 37.

Health Commissioner Steven Stack said on KET's "Coronavirus Update" Friday night that the IHME  projections "seem to me to be more optimistic than a number of other sources that are publicly available."

Beshear reported six more deaths Friday, for a total of 37, and 90 more confirmed cases, for a total of 831. "We are not escalating every day," he said. "I believe that’s directly attributable to the steps that we’re taking, and your hard work . . . 90 will become a small number moving into the future [but] it's better news at least than many are having."

Here is other news on covid-19 today:

• Beshear said the deaths were two women in Louisville, aged 60 and 88; two men in Louisville, 64 and 69; an 85-year-old woman in Madison County, and a 66-year-old woman in Hopkins County.
• Baptist Health Lexington has used blood plasma from a recovered covid-19 patient "as a potential treatment for two critically ill covid-19 patients," the hospital announced. "The mortality rate for patients in their conditions is 50 percent to 80 percent, according to Dr. Mark Dougherty, infectious disease specialist and ... epidemiologist," the Lexington Herald-Leader reports. "But he said the two patients were improving and that he was “cautiously optimistic” about their conditions."
• "Many frontline health-care workers’ protection is being sacrificed for the sake of conservation," Alex Acquisto reports for the Lexington Herald-Leader, in a chilling story about the critical shortage of personal protective equipment.
• Beshear announced a toll-free number to guide donations of PPE: 1-833-GIVE-PPE. He said donations are being accepted at state police posts and Transportation Cabinet district offices in Louisville and Lexignton. "I believe we have millions and millions of pieces of PPE that are out there in Kentucky," he said.
• Beshear called on 3M Corp. to temporarily license its patent for the badly needed N95 respirator mask so other companies can make it, and President Trump invoked the Defense Production Act "to ensure the federal government acquires more N95s," the Louisville Courier Journal reports.
• The University of Kentucky said it would convert its football practice facility, Nutter Fieldhouse, into a 400-bed field hospital.
• UK researchers and faculty have formed a workgroup "to focus on advising covid-19 patient care and clinical trials based on emerging research and potential treatment options," UK says.
• Kentucky homeless shelters say the state's homeless are highly vulnerable to the coronavirus, and the shelters have asked Gov. Andy Beshear to use some of the state's emergency federal money to help them, the Herald-Leader reports.
• "Four in 10 Americans are not properly allowing disinfectant sprays and wipes to kill the viruses and germs that can make us sick," says the American Cleaning Institute, citing a poll it commissioned.
• Stomach pain, diarrhea, nausea without vomiting and loss of smell could indicate you have the virus, Louisville's health director says.
• Music can help people deal with the stress caused by isolation and other ramifications of the coronavirus, an Ohio State professor says.
• Asked by Kentucky Health News about farmers' markets, Beshear said social distancing must be practiced, and there should be one big change: "If you touch it, you buy it."
• Louisville Mayor Greg Fischer urged retailers that are still open to enforce social-distancing rules. "Everybody has to act like they have the virus. . . . Put six feet of live-saving space between you and other people. . . . This is not negotiable." He said he would have to close parks and other public spaces if noncompliance continues.
• Bank and real-estate lobbies have asked Beshear "to put guidelines in place for county clerk’s offices, saying that their closure halts essential services," the Lexington Herald-Leader reports. "While some clerk’s offices have remained open or adjusted their operations, others have closed in an effort to help slow the spread of covid-19." Beshear said Thursday that the Kentucky County Clerks Association told him it was working with the groups that sent the letter to address their concerns.
• With the Centers for Disease Control and Prevention expected to recommend that Americans wear masks in public, the town of Midway, population 1,700, is rounding up volunteers to make them.
• The type of fabric used in homemade masks "is key to their effectiveness, according to tests performed at Wake Forest Baptist Health," it says in a news release. "The best-performing design was constructed of two layers of high-quality, heavyweight “quilter’s cotton” with a thread count of 180 or more, and those with especially tight weave and thicker thread such as batiks. A double-layer mask with a simple cotton outer layer and an inner layer of flannel also performed well. . . . The inferior performers consisted of single-layer masks or double-layer designs of lower quality, lightweight cotton."
• Responding to increased consumer demand for eggs during the pandemic, the Food and Drug Administration is allowing grocery stores to sell eggs in unlabeled flats and cartons that are typically sold to restaurants and bakeries.
• Senate Majority Leader Mitch McConnell told McClatchy Newspapers that there are “bound to be plenty of mistakes” with implementing the covid-19 economic-rescue package. “You can’t pass a bill of this magnitude in a week and have a perfect implementation of $2.2 trillion.” The Washington Post has details.
• The Herald-Leader and the Courier Journal did front-page stories on the Dawson Springs church whose revival sparked a covid-19 outbreak in Hopkins and other counties.
• Covid-19 "seems to be causing gun sales to skyrocket across the country, but  . . . Kentucky was the only state to have a decrease in gun background checks, according to data released by the FBI, the Herald-Leader reports.
• A Northern Kentucky woman is suing Beshear and Attorney General Daniel Cameron in federal court, challenging Beshear's order that people entering Kentucky from other states must quarantine themselves for 14 days.
• "A Lexington-based uniform company that provides N95 masks to police has been accused of price gouging by two Arizona lawmakers," the Herald-Leader reports. Galls, a uniform, equipment and gear store, was targeted in a letter to U.S. Attorney General William Barr Wednesday. "Galls provides masks to Phoenix’s police and fire departments, according to a letter posted online by Scripps." UPDATE: Gall's said it would sell to the agencies without making a profit.

State health department is sending nurses to jails, treatment centers, homeless shelters, other sites to give hepatitis A shots

Nurses administered vaccinations at the Fayette County
Detention Center. (Cabinet for Health and Family Services photo)

The state Department for Public Health has sent a team of nurses to give hepatitis A vaccinations at county jails, state probation-and-parole offices, homeless shelters, treatment centers and drug stores, the Cabinet for Health and Family Services announced in a press release.

"Since April, the team has provided more than 2,100 vaccines at 40 different sites," the release says. "The state is collaborating with local partners on harm-reduction programs, aimed at reaching those who are most at risk. At least 18 additional vaccination events are scheduled through August."

“We have found it particularly challenging to reach the at-risk population in rural Kentucky,” said Dr. Jeffrey Howard, commissioner of the department. “One reason is the stigma associated with substance-use disorder. In some of our rural communities, more than 80 percent of hepatitis A cases have occurred in those with SUD. Due to the stigma surrounding SUD, the at-risk population is often hesitant to seek preventative care.”

The department identified the outbreak in November 2017, and has been criticized for not reacting more robustly to it. It has identified 4,700 cases, almost half of them requiring hospitalization, and 58 deaths have been linked to the outbreak.

"Kentucky was the first state to experience a large, rural spread of the disease," the press release says. "Similar to outbreaks in other states, the primary risk factors have been illicit drug use and homelessness. A contaminated food source has not been identified, and transmission of the virus is believed to have occurred through person-to-person contact. Hepatitis A is a highly contagious liver infection."

Bowling Green's 'street medicine' program for homeless serves 60 per month, is one of few in small metropolitan communities in U.S.

Street medicine coordinator Melissa Cowles talks with William
Schultz after giving him a new hat and jacket near the Bowling
Green Public Library. (Daily News photo by Austin Anthony)

Bowling Green, Kentucky's third largest city with an estimated population of 68,000, has a "Street Medicine" program that treats the homeless "with basic medical care and services three times each week, wherever they might be," reports Caroline Eggers of the Bowling Green Daily News.

The program is run by Hotel Inc., a local nonprofit that uses all capital letters in rendering its name. "In 2012, HOTEL INC patients were treated at the office once weekly by a nurse practitioner," Eggers writes. "They began literal street rounds in 2014, after training under Dr. Jim Withers, a pioneer of street medicine in the U.S."

The program "serves about 60 people each month with 150 services," Eggers reports. "The street medicine team conducts vital checks, dresses wounds, arranges doctor’s appointments and team members instruct clients on how to be compliant with doctors, how to get medications and how to find transportation."

Practicing street medicine is “a radical plunge into the reality of excluded people,” Withers told the newspaper. “It’s a no-brainer; it’s where the really sick people are.” He said homeless populations in smaller communities can be overlooked. “If you’re outdoors in a small community, you’ve really run out of options,” he said. “Most people really cling to the indoors.”

"As one of the only small cities with street medicine programs, Bowling Green serves as an example for similar-sized communities," Eggers writes. In 2018, the nonprofit "received a grant to mentor a new street medicine program in Northern Kentucky.

The Bowling Green program "is partially grant funded, and partially funded by private donations," Eggers reports. Its annual budget is "about $49,000, but it’s variable. They’re currently working with about $8,000 from two grants and are planning to renew the same grants in the spring with the Good Samaritan Foundation and WellCare Health Plans.