D.C. Public Housing Units Become Health Care Hubs

July 15, 2024

Authored by:

Ruth Steinhardt

Erin Athey has spent decades working in community medicine in Washington, D.C., a career that made her painfully aware of the disparity in care access between the city's high-income and low-income residents.

"There is a 20-year difference in life expectancy between the White House and Ward 8," the then-assistant professor and current adjunct at the George Washington University School of Nursing said. "So this is a system that needs a massive overhaul."

During the COVID-19 pandemic, while running a series of mobile clinic events with the District of Columbia Housing Authority (DCHA), Athey noticed that DCHA properties often have a small number of offline units reserved for community service providers. An epiphany dawned: Could these unused public housing units be used as "wellness hubs," providing convenient health care services in the communities that need them most?

Athey started sketching out ideas on a napkin. In addition to the units that could potentially be repurposed into clinics, some DCHA properties also have large community spaces, which Athey realized could be used for educational events and free gatherings. Brainstorming "was an iterative process," Athey said. "I was really trying to think about how we could anchor these health care services out in the community."

Due to her longstanding relationship with DCHA, Athey was able to consult with and quickly gain support from colleagues at the agency. "I shared with them that instead of just these mobile pop-ups we were doing, maybe we could establish some permanent mini-clinics along those same routes," she remembered. "And because of COVID, I think there was sort of an urgency for them to say yes."

Athey applied for and won funding from a Johnson & Johnson Quickfire Award, which she used to start her company, C3 Cares. C3 Cares now runs four clinic locations in DCHA properties in wards 6, 7 and 8, offering a range of services from vaccination to general primary and preventative care. Each is overseen by a nurse practitioner and staffed by an on-site public health nurse and a community health worker. The latter, Athey said, are particularly essential to the clinics' success: As employees drawn from the residential community, they are trusted neighbors who can spread the word about the clinics and also ensure that they offer services targeted to community needs.

"A lot of folks in the community are used to using the emergency room as their primary care provider," Athey said. "So there are educational needs when it comes to increasing engagement in care, and community health workers can help us bridge that gap with the community."

Turning residential units into functional clinics wasn't always easy, Athey said. The spaces had to meet rigorous accessibility and safety criteria set by three separate state and federal authorities-not just DCHA, but also Medicare and the D.C. Department of Health. Since many DCHA properties were built before the Americans with Disabilities Act (ADA) of 1990, there was no guarantee that spaces in those communities would be approved and getting them up to that standard took years. But Athey and her team stayed focused. The first clinic they opened was a ground-floor, formerly two-bedroom unit, retrofitted into a cozy space with a small lobby, a kitchen area, a restroom and two examination rooms. Now, her focus is on spreading the word and providing exemplary care to patients.

"Our motto is 'Let's get better together,' meaning of course the patients but also the health care system," Athey said. "People have had terrible experiences with health care, especially in these under-resourced areas, so there is a certain amount of distrust. But we use a nurse-led model that is very patient centered. Instead of telling you what's wrong with you and what you need to do, we want to talk about what's going on, set goals together and help you meet them. We want to be sure folks understand the health information they're getting, and we also do care management in between visits to check in and make sure the patient is supported. It's a treatment model for the whole person."

Though she's focused on strengthening and expanding C3 Cares, Athey hasn't left GW behind. She still runs practicums for the School of Nursing's community health rotation, giving student nurses firsthand experience in the field that matters most to her. And she credits her mentor at the school, Associate Professor Emerita of Nursing Kate Malliarakis, with giving her the encouragement to see her napkin drawing into reality.

"I just feel very connected to GW; I feel like I have roots there," Athey said. "I feel like it's been a little family for me, even as I've kind of moved out into the community more."