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River City Medical Group (RCMG) is a “progressive Independent Physician Association (IPA) uniquely dedicated to serving the Medi-Cal population” and they contract with over 1,600 network physicians who serve approximately 600 provider and clinic locations throughout the greater Sacramento area.

“We are owned and operated by practicing physicians and our Board of Directors is made up of practicing doctors,” Janice Milligan, Vice President of Community Relations & Program Development at River City Medical Group, said.

According to Amanda Gray, Marketing & Communications at River City Medical Group, “we have dedicated and experienced associates who handle claims, conduct training, and provide resource development for provider offices. The goal is to help our doctors focus on providing health care.”

As the only exclusively Medi-Cal medical group in the area, RCMG serves over 180,000 Medi-Cal members through their contracts with four of the participating Sacramento GMC health plans – Aetna, Anthem Blue Cross, Health Net and Molina.

“The reason the doctors came together was they recognized that in Sacramento there were large communities of people who were having difficulty accessing culturally competent care,” Milligan said.

From this stemmed RCMG’s mission, which is “to recognize and meet the needs of our diverse cultural and socio-economic communities while treating our members with compassion and respect. We strive to provide quality health care, using our resources responsibly to benefit our patients,” Gray said.

RCMG stands out as one of the largest Medi-Cal IPAs in Northern California and they work closely with their Sacramento network, including Peachtree, One Community Health, SNAHC, Wellspace, HALO, Sacramento Family Medical Centers, Whole Health Community Clinic, and Elica Health Centers.

“Our Medical Directors and nurses work with Sutter Hospitals, Dignity Health (Mercy), UC Davis, Kaiser Permanente, Adventist, and many of the Bay Area hospitals to coordinate the myriad of healthcare services our patients need,” Gray said. “As an integral part of the Sacramento community, RCMG works collaboratively with many community-based organizations who share our passion to bring healthcare resources to underserved communities.”

This kind of collaboration is what sparked a relationship between River City Medical Group and Joshua’s House.

“RCMG coordinates hospice services for our members experiencing terminal illness and we recognize that Joshua’s House is a much-needed resource in our community. Our doctors see patients who are terminally ill and for those patients who are experiencing homelessness many hospice programs have not been practical. Joshua’s House will fulfill the true definition of hospice for these patients,” Gray said.

“In Sacramento and in every community in California, we have a long way to go when it comes to helping people who are homeless participate in their care by mitigating so many of the social barriers and behavioral health barriers,” Milligan said. “I can’t imagine anything that’s more rewarding than bringing together all of these resources for doctors to help their patients who have a tough time participating in their healthcare.”

Last month we met with Kristy Catchings in Pollock Pines, just an hour’s drive from Sacramento towards Lake Tahoe. She lives in a house with large windows, nestled in the hills dense with pine trees. For as long as she can remember, her sister Lynette Godfrey had always seemed troubled. She often acted out and ran away from home.

This was in the 60s. Her family lived in a rural Midwest town where children were taught to be seen and not heard. Parents did not openly discuss their troubles with others much less with school psychologists or mental health professionals. Kristy recalls, “This was a time and place where things like mental illness and sexual abuse were tucked neatly away in the closet. People who suffered mental illness were often put into facilities.”

Lynette was eventually diagnosed with schizophrenia but not until she had become an adult. By this time, she had become self-medicating and addicted to drugs. She lost custody of her son and eventually had to live on the streets. This life style was incomprehensible to her family. While they made every effort to help her, the forces of homelessness, drug addiction, and mental illness were just too great.

Kristy recalls the last time she saw her sister. In 2009, she found Lynette by combing the streets of San Diego and asking homeless people for her whereabouts. “They were living on the streets in cardboard boxes. I had to step over feces and puddles of urine.” Kristy had one surprising consolation. People would greet her warmly and talked about Lynette with fondness. They were always smiling and very happy despite their circumstances. “I could see the humanity in their eyes. They may have been homeless, but they were real people who have the same emotions and spirit as others.”

Kristy met Lynette in Balboa Park. Lynette’s was gaunt. She lost her front upper and lower teeth. She had dark circles under her eyes, yet she ran towards Kristy as if she hadn’t a care in the world. Beaming from ear to ear, Lynette introduced Kristy to her boyfriend and announced that they were getting married. The two people in front of her were in love and they were planning their future together just as she and her husband were doing. Despite their appearance, she saw in in them a sense of normalcy.

Later that year, however, Lynette died of a brain aneurysm, most likely brought on by her heavy drug use. “The thought of Lynnette lying on the street while taking her last breath and not being surrounded by her family is just heartbreaking to me,” Kristy stated. At her funeral, her boyfriend got up to speak. He was distraught over her passing. He immediately began sobbing. While Kristy empathized with him, others seemed annoyed and embarrassed that he was making a spectacle of himself. “They were probably thinking, who is this crazy guy,” Kristy said.

In hindsight, Kristy wishes that her family had sought help for Lynette when she was a child. She said, “As an adult looking back at events, I can see clear signs where my sister was crying out for help. Her unaddressed issues lead into a downward spiral she never could recover from.”

Kristy and Lynette lived in a blended family. Their parents felt that Lynette’s behavior was a reaction to her biological parent’s divorce and having adjust to her stepfather. As Lynette grew older, she started to hear voices, which her parents thought, were demonic. They did not understand nor seek help for her schizophrenia, which was the root of the problem according to Kristy.

By telling her story, Kristy wants to help other families avoid losing their loved ones to mental illness and homelessness.

CBS13 Sacramento broadcasted this story about Joshua’s House on February 21. Special thanks to reporter Angela Musallam and to John Gay for his interview.

Yolo Hospice social worker Nancy Johnston

Twenty years ago, social worker Nancy Johnston found housing for children whose mothers were dying of AIDs in New York City. This prepared her for a career in hospice care. Now she works for Yolo Hospice in Davis, CA. She says that hospice facilities for the homeless are hard to find. Sometimes it’s on the streets, but this is not a practical or humane option.

In caring for terminally ill homeless people, she says, “Everyone has a different story and you must figure out what is meaningful to them as they approach the end of life. It doesn’t take very much.”

With a mission to transform lives and a vision to set the standard as a place that provides quality care in a supportive community, One Community Health is succeeding as a leader for health care services in Sacramento.

The clinic originally started in 1989 as the Center for AIDS Research, Education and Services (CARES) in an apartment with one provider and one nurse, but in 2015 it became a Federally Qualified Health Center (FQHC). Today, One Community Health provides a full range of services for Sacramento County, including medical and dental care, substance abuse treatment, nutrition education, and mental health services.

“We provide all these services in a single location, so we are able to reach out and pull more people in who have a need,” One Community Health CEO Christy Ward said. “It’s really wonderful when you hear some of these individuals’ stories and hear about the impact that even small things have on them as an individual.”

Ward joined the clinic in May 2016 after leaving her position as the Chief Executive Officer at the Multnomah County Health Department in her long-time home of Portland, Oregon. Although she had never been to Sacramento, she recognized what One Community Health was providing for the community.

“At all levels of the organization, in the clinic as well as the board of directors, everyone wants to give back to the community and they want to grow and provide services for more people,” Ward said.

For One Community Health, that sometimes means going beyond addressing just the medical concerns.

“We want to achieve the best health possible for each individual person,” Ward said. “We’re thinking of the social determinants of health, like food and security, housing, safety, and those types of things. We try to take each person and identify their barriers and help to sort through those as well as we’re able to.”

Ward believes the best way to help the community is to make sure people know One Community Health is there for them.

“We will always see somebody regardless of ability to pay. We’re here and we’re always going to be here,” Ward said.

One Community Health has seen many recent expansions to help them achieve their goal of always being there for as many people as possible. In December, they opened a new clinic in the Arden Arcade area. On Jan. 22, they expanded their clinic in Midtown from 17 medical exam rooms to 42 rooms and three dental chairs to nine chairs. They also added a full-time podiatrist, a full-time chiropractor, and women’s health experts and have a goal for 2018 to hire more staff and providers and add acupuncture and other specialties.

Ward also serves on the Board of Directors for HCRI, Inc./Joshua’s House.

James Fitzhugh - Homeless in Sacramento

I met up with James Fitzhugh at Friendship Park on the campus of Loaves & Fishes last month. His story reinforced what I’ve known and seen for a long time: anyone can become homeless. James went from middle class to homeless very quickly.

James held senior management jobs at several high tech companies. Later he even managed a ski school. He was well off and enjoying life. And he had a compassionate side, once helping a friend who had a serious alcohol addiction.

James describes his state of mind being homeless, what it does to his soul, and how today he’s trying to make a comeback.

Recorded at Loaves & Fishes, Sacramento. Produced by Ted Fong.

David Whitworth - Disabled and Homeless

Just before Christmas, I met with several homeless people at Loaves & Fishes who agreed to be interviewed on camera. They told us about the physical and emotional pain of living day to day on the streets of Sacramento.

We begin with David Whitworth who was recently attacked and left paralyzed on one side of his body. Ironically, he can get in-home care, except for the fact that he has no home. As you’ll see in this video, he gets very emotional about issues that affect all human beings. He accepts death and dying as a natural process, but makes a heartfelt plea to viewers to show compassion to people who have no where to go when their time is up.

Please watch this 2-minute video, share it with others, and tell us your thoughts. I would like to thank UC Davis Health for sponsoring this project.

Recorded at Loaves & Fishes, Sacramento. Produced by Ted Fong.

As a minister and hospital chaplain, Julie Interrante cared for terminally-ill patients
for 25 years. She now works as an end-of-life educator in Sacramento. I am
delighted that she’ll be providing spiritual care at Joshua’s House.

In August, I met Julie at the Clunie Community Center in Sacramento for a recorded
conversation. Standing tall, she was casually dressed and very upbeat. Julie also
exuded an inner peace that made me even more eager to discuss her calling to end-
of-life work.

Julie shared her career journey with me, the one that transformed her into a skilled
and compassionate hospice professional. But what really allowed her to help people
was to experience a “broken-open heart” early on as a result of her hospice
encounters. In fact, she wrote a book about it. This awaking allowed her to make a personal decision to grow spiritually. And over time, she found it easier and more satisfying to help others.

Julie made two points that really stuck with me. The first is that end of life is the
great equalizer. People are all the same regardless of net worth, social class, and
housing status. “We all need attention and tenderness during the completion of our
life. It’s all part of being human,” says Julie. Hospice workers and especially spiritual
advisors can provide this.

The second is that word “dying” is not the right term. “We’re living until we are no
longer living.” While someone may be out of medical options, the process of
completing one’s life is just beginning. Julie says no one wants to be alone and no
one wants to be forgotten. They want to create a legacy that says, “I was here.”
There is so much that hospice programs can do to make this wish come true.

Julie is excited about working with Joshua’s House. I am just as excited to have such
a beautiful and compassionate person on board.

Helping the forgotten not to be forgotten. This month’s Inside the Grid takes a look about this special place, Joshua’s House, where terminally ill homeless men and women can receive hospice care and live their final stages of their life with love, dignity and respect.

According to the recent 2016 Annual Homeless Assessment Report to Congress on a single night in 2016, over half a million people were experiencing homelessness in the United States of America.