A Puerto Rico Community Hub Meets Urgent Need for Health and Housing

It was 2020, a pandemic was on the rise, and Francisco Maysonet Valle was only there for breakfast. He'd already spent 30 years living on the street, and had lost contact with his two daughters. But the advice he heard at La Fondita de Jesús, on an early morning four years ago, changed his life.

"An old man told me to give this place a chance. That they would help me. And because of that advice, I am now here in Fondita," said Maysonet, who is now a volunteer and Board member at the community-based nonprofit organization.

For 38 years, La Fondita de Jesús has worked to meet urgent needs in Puerto Rico. The organization focuses on support and care for people experiencing homelessness, seniors, and other vulnerable groups.

Located in the San Juan area, their site serves as a hub addressing gaps in primary, preventive, and mental health care, including treatment for substance use disorders. Case managers and social workers connect people to services and resources.

The site also offers daily meals, shower facilities, clothing, job placement assistance, recreational activities, and transportation.

Homeless Outreach

Dr. Josué Segarra Lucena, who has been at LFDJ for almost two years, joined because he wanted to work with unsheltered patients.

"I wanted to be the person-alongside the team-to connect homeless individuals with healthcare services," Segarra explained. Because so many of his patients feel neglected and abandoned, reaching out - and eliminating the barriers that keep people from accessing medical care - is vital.

"We like to receive them as they are, because [we know that] being homeless disrupts everything from physical to mental health," he added.

Some patients have not received medical care in over 10 years, so LFDJ staff begin by providing a comprehensive evaluation. Hypertension, high blood pressure, and ulcers often need to be addressed immediately.

While they provide health care support no matter the circumstances, they face some limitations. For example, since Dr. Segarra is a general practitioner and La Fondita does not have contracts with insurance companies, he can't be a primary physician for their participants.

"That doesn't limit us in providing preventive healthcare, linking them with primary and even specialty physicians. We always try to ensure that the patient receives the attention they need," Segara said.

Helping patients navigate Puerto Rico's healthcare system is a high priority. An unsheltered or underserved patient who needs medical insurance may be asked for documentation they don't have, which means that many LFDJ patients can't access public support without the help of social workers and case managers.

Mobile Health Care

When Hurricane María struck Puerto Rico in 2017, many of the hardest-hit communities were in more rural areas, where help was harder to reach.

LFDJ staff, offering outreach to devastated patients in the storm's aftermath, "were able to see up close - even though we were aware - that there was a population that needed more. Even though they had a home and a roof over their heads, they lacked everything from essential services to much-needed physical and mental health services," recalled Josué Maysonet Colón, the organization's executive director.

That on-the-ground view sparked a new focus on preventive care in vulnerable communities across the island, which LFDJ has continued and expanded over time. In 2022, Direct Relief donated a mobile medical unit for this work.

Every two weeks, LFDJ and Direct Relief embark on a mobile care circuit, visiting six communities at least twice to deliver health care services, hygiene kits, and solar-powered lights.

"This is one of the most important things Fondita provides to Puerto Ricans," Maysonet said.
Dr. Segarra also provides care from the mobile unit, focusing on vulnerable communities and unsheltered individuals. Through mobile outreach, LFDJ has provided versions of their on-site care to 37 municipalities across the island, including Vieques and Culebra, both smaller islands off of Puerto Rico's east coast where hurricane devastation has created long-term needs.

Direct Relief's medical advisor in Puerto Rico, Dr. Pedro Juan Vázquez, travels with the mobile clinic. He goes from house to house, visiting patients who are immobile or confined to bed alongside LFDJ's social workers, frequently working on the spot to connect patients to providers or alert a patient's doctor to an acute issue.

While most patients in these communities have medical insurance, Dr. Segarra observes that this isn't always enough. Particularly among older adults, he's seen an increase in care lapses and patients who skip their medications.

For this reason, the mobile unit, which enables an on-the-ground presence, is key: "We provide them with orientation regarding the importance of visits to their primary doctor and the importance of treatment adherence. I am an advocate for orientation and prevention; it's the key for a healthy population," Dr. Segarra said.

The goal isn't to impose on patients, but to invite them to the table. LFJD staff encourage patients to share their needs and perspectives, which in turn inform the organization's approach to community health.

Changing Landscapes

Homelessness has a devastating impact on health, so addressing it is key to LFJD's work. With federal funding from the Department of Housing and Urban Development (HUD), the organization has long provided housing support for unsheltered people and groups vulnerable to housing insecurity, including members of the LGBTQIA+ community and older adults.

When a new patient undergoes an assessment process, housing needs are part of the picture. If the person is considered eligible and housing is available, they are placed in a unit.

"I began receiving treatment and help and was placed in a housing unit. I am now stable, healthy, and I'm one of the volunteers that works here," said Maysonet, who is also a member of the Board of Directors.

A 2024 report estimated that 2,096 people are homeless in Puerto Rico. While that number is slightly lower than 2022 estimates, the number of people living on the streets has increased, representing more than 55% of the unhoused population.

People cited unemployment, consequences from natural disasters, drug and alcohol use, and family problems as the main reasons for homelessness. Additionally, more than 10% of unsheltered individuals reported experiencing gender violence.

Last year, the organization implemented a new program called Las Familias de la Fondita, or Families of La Fondita, to expand assistance and cover basic needs of families with children 18 years or younger who are unsheltered or at risk of losing their homes.

In the first 30 days of the program, more than 60 cases were referred to them. Many families were escaping from gender violence. Parental fear of having their children removed by state agencies further exacerbated the problem, staff said.

Some families seeking housing support have been evicted by landlords. A number have reported that their rents were nearly doubled, or landlords decided to convert residential housing into short-term rentals.

Maysonet reports that needs have changed: Until recently, most patients who needed housing support were unsheltered adults. Now, they work with all ages and with people fighting to keep a roof over their heads.

The increased demand brings new dangers. Before the pandemic, it might take two weeks to place someone in housing. Now it can take as long as a year. "During that time, many things can happen. Someone whose mental and physical health was stable" may experience rapid deterioration, Maysonet said.

A changing landscape of health and housing demands that LFDJ adapt. But staff say they're up to the challenge.

"All of these things we've been learning along the way…give us an outlook into emerging needs that these populations have. We continue creating programs that address those needs," Dr. Segarra said.

Since 2021, Direct Relief has provided La Fondita de Jesús with more than $300,000 in medicines and supplies and provided $350,000 in grant funding to support community outreach efforts across the island.

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