A Closer Look

A monthly in-depth look at issues affecting people experiencing homelessness and the broader Health Care for the Homeless community

As ICE Activity Ramps Up, Health Care Professionals Share Strategies to Improve Access to Care and Staff Morale

As federal immigration enforcement ramps up in communities across the country, health care providers — including those in the Health Care for the Homeless (HCH) Community — are seeing direct impacts on patients and the care they receive.

Hospitals are contending with Immigration and Customs Enforcement (ICE) agents in exam rooms. CMS is giving addresses from Medicaid rolls to immigration officials, causing patients to be afraid to go to the hospital or apply for benefits for which they are eligible due to fears of deportation. Recently, the administration proposed a policy (now on hold) that would prevent health centers (like HCHs) from serving many non-citizen patients. All these actions have a significant impact on care.

NHCHC staff spoke with direct care providers in 15 communities across the U.S. about their experiences. Four common responses include:

  • Care is being compromised: Patients are avoiding care and suffering adverse health outcomes.
  • Fear is impacting patient health and well-being: Patients are avoiding hospitals and emergency rooms, mental health is deteriorating, and landlords and employers are exploiting vulnerabilities and housing stability.
  • Staff are demoralized: Staff are feeling powerless to protect patients and experiencing significant moral injury, exacerbating burn-out. Staff of color (citizens included) are fearful of being stopped by ICE because of “how they look.”
  • Public health is at risk: Avoiding care compromises chronic disease management and preventive care, and elevates the spread of communicable disease, especially when flu and other respiratory illnesses are at high levels.

At the same time, HCHers described myriad strategies they use to improve patient access to care and help address staff burnout. Importantly, these are strategies that can be applied to all patients.

Strategies to Improve Access to Care and Staff Morale

  1. Offer care in a variety of locations: Telehealth, street medicine, and home visits (if staff feel safe) help to reach people who may not be comfortable traveling to the clinic.
  2. Stock up on medicine: Offer multiple months of medications (if possible) so patients have sufficient supply if they are unable to refill their prescriptions on time. Stock extra medications at the clinic for patients who are concerned about going to the pharmacy. Street medicine and mobile outreach vans should carry extra supplies and medications for the management of chronic conditions such as diabetes and hypertension
  3. Ensure front desk staff speak familiar languages: For patients coming to the clinic, ensure frontline staff speak Spanish or other prominent languages to provide a welcoming environment and help reassure patients that the clinic is a safer place.
  4. Provide hard copies of medical records: Offer to print out copies of medical records so patients have documentation of medical conditions and/or prescriptions in case they need to leave the community.
  5. Identify and enforce "private clinical areas" in physical clinic spaces: Federal immigration activities do not nullify privacy/HIPAA requirements. Clearly post signs marking private clinical spaces to protect both patients and staff. [See resources below.]
  6. Discuss guardianship plans for dependent children: Parents expressing fear about their children’s welfare in the event of an arrest can document guardianship preferences in their medical record or other documentation.
  7. Create supportive spaces for staff: Hold group discussions for staff to share information, express personal feelings, and promote ideas for ensuring a safe clinical space for everyone.
  8. Support impacted staff: Staff who are immigrants themselves or part of immigrant families are also directly impacted. Consider what supports and accommodations can be extended to team members who are also experiencing fear and may be struggling to fulfill work responsibilities.
  9. Hold “Know Your Rights” trainings: To ensure all staff are prepared to appropriately respond if ICE comes to the clinic, conduct trainings and drills to ensure safety and privacy/HIPAA laws are maintained. Include staff who work in shelter-based, mobile, or street environments and ensure the unique aspects of those venues are considered. Look for opportunities to offer these trainings to patients/community partners as well. [See resources below.]
  10. Connect with local immigration/legal advocacy groups: Engage community partners who specialize in immigration and/or legal rights to share information, resources, and guidance. [See resources below.]

Additional Immigration-Related Resources

Use the resources below to know your rights and use your power where you can. Root your work in our mission to deliver high-quality care. Bear witness and document the experiences of patients and staff. Show up for patients however you can, prioritizing safety, access to care, dignity, and compassion.

“Visits are increasingly complex. Even routine blood pressure checks turn into therapy sessions because of the fear, anxiety and stress over being separated from their children or their partner.”

- Physician

“I have regular, stable patients I haven’t seen and I’m worried about them. There’s a woman with diabetes, another woman with uncontrolled blood pressure and gets chronic headaches, and yet another woman with significant depression who must be out of her meds by now.”

- Physician

“I am seeing patients who should have gone to the ED days ago: stroke-level blood pressures, severe asthma attacks, mothers with newborns—they come here because they don’t feel safe elsewhere. It increases risk of mortality and impacts every member of the family.”

- Nurse

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