“I don’t want to end this conversation pretending that our work is race neutral, because it’s not,” said Rodolfo Rodríguez, director of the health & wellness ecosystem at the Housing Authority of the City of Austin (HACA).

“When you take a big step back, COVID came to the US because privileged people brought it over… And it’s communities of color that are being hit the hardest… And we’re not at greater risk by genetic or racial form. It’s because of the health care inequities.”

It’s these underlying inequities that Rodolfo and his team (Myra Rubalcava, Joanna Saucedo) at HACA are trying to address with a new program called Bringing Health Home, which they described in an interview with The Austin Common earlier this week.

Created last year in partnership with the Dell Medical School and HACA (and funded by the St. David’s Foundation), the idea behind Bringing Health Home is to create a whole health approach, combining housing and health, and empowering HACA residents to steer the program and advocate for what they need.

For those who are unfamiliar, as Rodolfo describes it, HACA is “Austin’s largest low-income landlord,” providing housing through a variety of different programs to nearly 20,000 Austinites. They do this through traditional public housing (HACA runs 18 properties throughout the city) and Section 8 Housing Choice Vouchers, subsidizing private landlords to provide housing at a lower cost.

But they do a lot more than just housing. They also serve as a community builder and service provider for their residents in three ways – workforce development, youth education, and health and wellness.

That’s where the Bringing Health Home program comes into play. It all started with a community needs assessment, conducted in 2018, that found out that about half of residents hadn’t been to a primary care physician in the past year and about 40 percent had been to an emergency room for care.

“And when that happens, people don’t get their chronic disease needs met,” said Dr. Freya Spielberg, an associate professor at Dell Medical School and the Medical Director of the Bringing Health Home program.

It’s exactly these chronic diseases that are now making people more vulnerable to hospitalization and death from COVID-19.

“And it really points out a big gap in our current health care system,” Dr. Freya said. “People that experience barriers to health – transportation, childcare, just health literacy. It’s really hard to get to a clinic appointment, and so what we’re trying to do is fill that gap.”

With the Bringing Health Home program, HACA and Dell Med have been filling that gap with Resident Community Health Workers who literally knock on people’s doors, ask them what they need, share health care info, and take their vitals (things like blood pressure and sugar levels).

Myra Rubalcava is one of these Resident Community Health Workers, as well as a resident of HACA. She explained that just this simple act of checking vitals has made a big difference, helping people identify and get treatment for conditions they didn’t even know they had.

Of course, all of this face-to-face interaction has been cut out because of COVID-19, but because HACA already had this Bringing Health Home program in place, they were able to quickly transition to serving their community during the pandemic as well.

“When COVID came on the scene, we were perfectly set up to meet that need of reaching people…” Dr. Freya said, because they already had the trust and that baseline within the community.

At the end of March, the HACA and Dell Medical School team launched a new pilot COVID-19 program at its Booker T. Washington housing complex. Since they had already been running the Bringing Health Home program there, they were able to easily contact residents (via phone), especially those at risk (since they already had information about their health status). Resident Community Health Workers began checking in with residents, making sure they had access to food and using an assessment tool (developed in partnership with Dell Med) to determine whether or not someone should get tested for COVID-19.

Residents are also being given a specialized relief package with food, disinfectant supplies, and an O2Sat monitor (so they can track their blood oxygen levels and determine when it’s necessary to go to a hospital).

So far, the program is working pretty well, but problems still exist. According to the HACA and Dell Med team, transportation has been a big barrier for residents needing to get tested.

“We’re seeing a lot of people that have symptoms, that qualify for testing, that should be tested, and there’s literally no way to get them to the testing site,” Dr. Freya said, especially since residents don’t want to transmit COVID-19 to others by going on public transportation or taking an Uber or Lyft.

Going forward, the team hopes to share these concerns raised by their residents with the broader Austin community, so the city can continue to address these larger systemic issues.

At the same time, they also hope to inspire other cities to adopt home health models at other public housing sites across the country.

“It’s good for us to cover our own ground,” Rodolfo said, “but COVID is global, so there is definitely space for others to be inspired by this model, figure out how this works, and launch it in their own city.