Bridging Compassion and Resources to Help Patients Find Hope

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Equipped with compassion, Sanford Community Health Workers (CHWs) assist patients in getting access to basic needs and essential support. As a rural health system, Sanford Health’s CHWs focus on working with patients in the primary care setting to address chronic disease concerns and social determinants of health concerns.

Recently, the CHW team was able to provide services to a patient with uncontrolled type-2 diabetes and experiencing persistent food insecurity. The patient did not have any sort of income, which resulted in the inability to afford essential medical supplies, most notably insulin, which is vital for diabetes management, as well as basic necessities such as food. Due to the patient’s circumstances, he was relying on his roommate who was giving him canned soup that was a large portion of his diet. The patient also had a fall where he was unable to call for help until a well-check was called 19 hours later after he had his first no-show to an appointment in five years.

Carrie Hawley, RN Program Manager, at Sanford Health who oversees the CHW team says, “On those intense days, you’re building resilience, and that resilience is where you find your compassion.”

The CHW facilitated the patient’s enrollment in a food delivery program and assisted the patient with applying for SNAP benefits, both helping to alleviate the patient’s food insecurity. To address the patient’s financial situation, the CHW helped connect the patient with an attorney to aid in applying for disability benefits. The CHW also brought the patient’s financial situation to the attention of his care team, who had previously been unaware that he did not have any income, prompting a reevaluation of his medical regimen.

Additionally, the CHW connected the patient to the Capable Program, a person-directed, home-based program that addresses both function and health care expenses, thereby mitigating fall risk and enhancing his safety. The CHW and the Capable Team have been collaborating, working to arrange temporary assisted living accommodations to facilitate the patient’s recovery, strength regain, and restoration of independence.

Along with the approval of SNAP benefits, the patient now has increased accessibility to food, effectively mitigating food insecurity, and improving his sense of stability and well-being. The patient’s transition to more affordable medication alternatives has lessened the financial barriers that previously caused issues with medication compliance. The support of the Capable Program has increased the patient’s active engagement in physical activities, and he has expressed hopes to have a normal life again.

To learn more about CHW programs in South Dakota, visit www.CHWSD.org.