Housing is Health: La Maestra Community Health Centers

At the Core of Care

Published: November 1, 2021

SARAH: This is At the Core of Care. A podcast where people share their stories about nurses and their creative efforts to better meet the health and healthcare needs of patients, families and communities.

I’m Sarah Hexem Hubbard, Executive Director of the Pennsylvania Action Coalition and the National Nurse-Led Care Consortium. 

As part of our Housing is Health series, we’re going to spend this episode focused on the innovative care model at La Maestra Community Health Centers in San Diego.

Over the past 30 years, La Maestra has grown to become a national leader through its expertise in developing and implementing a social-determinants focused healthcare practice that takes an all-encompassing culturally competent solutions-based approach, and what the organization refers to as The Circle of Care.

La Maestra is a Public Housing and Special Populations Federally Qualified Health Center that has 18 primary care sites operated by more than 600 staff and many volunteers. Each year, La Maestra provides services to more than 45,000 people, specializing in care for mainly immigrants, refugees, low-income individuals and the homeless.

On this episode, we’re going to concentrate on how La Maestra supports a wide variety of housing needs. From programs for people living in public housing, experiencing transitional housing, homelessness and human trafficking...To counseling for renters, residents receiving public assistance, homeowners seeking financial management or how to avoid foreclosure. And even more recently, La Maestra has started developing and providing on-site housing.

Joining us from La Maestra Community Health Centers are Zara Marselian and Javier Rodriguez. Zara is the organization’s President and Chief Executive Officer and Javier is the Chief Medical Officer for La Maestra.

Welcome to At the Core of Care.

JAVIER: Thank you.

ZARA: Thank you.

SARAH: So before we dive into our conversation, let's hear first about how each of you ultimately ended up working in the community health field. Zara, can you get us started?

ZARA: Sure, thank you. Well, looking back, it seems like the journey to actually work in the community health center was kind of different than most people because I started off as an English as a second language teacher, vocational training. The field of education was, you know, kind of where I came from. And in 1986, we started La Maestra Center, which was an educational facility to help people apply for amnesty under the Immigration Reform and Control Act of 1986. And along with that, of course, came the English as a second language, civics, history and so forth, so people could get prepared to for the interview with immigration. And along that way, well, we had 12,000 students, and they said, ‘We really need you know, childcare, we need training for jobs. And so we developed those programs. And then the next big task was we need culturally competent health care within our communities. And what can you guys do about that? Well, we didn't know anything about health. But we sure we started learn about licensing, managed care, health care services. And now of course, you know, 30, some years later, we've developed very comprehensive services through our medical, dental, behavioral health, mental health services, we even have our imaging department. And we've kept all of those other social determinants growing as well over 30 years. So we have that nice collaborative network, across sectors of housing, food scarcity, human trafficking, youth development, and on and on. And I guess the integration of that Circle of Care model is the most important and that's what we keep working on, because that's what the community needs. And that's how I started basically.

SARAH: It is remarkable when you think about the complexity of the work that you're doing as well as the scale. And how about you Javier?

JAVIER: Thanks again for having us here today. My journey into medicine is similar to what people have probably heard before with an ill parent or ill parent and in my case, you know, since my parents were from Mexico, they immigrated in the early 70s. I was interpreting for them in high school, my dad namely because he had cancer and actually, I would drive him and also take him to the oncologist office, and I would be the one interpreting, you know, various treatment plans and whatnot. And so when I was about to enter undergrad, I thought, well, you know, I think I’d like to be a teacher and an administrator. When I was in my first year of undergrad, my sister who was studying Communicative Disorders, who was also by the way an audiologist said, Hey, it'd be cool if you could, you know, go into medicine. And I think that would be something you'd be great at. And then so I changed my major to go into biochem and molecular bio. And from there, you know, I got into medical school, residency. You know, back to my immigrant parents, they immigrated to work in agricultural, you know, agrarian society, if you will, very common, you know, for Latinos, and Mexicans, and others, of course. So I felt that working with our communities, as you know, that I was familiar with, with something easy, you know, especially because of language and then cultural competency, and, you know, understanding some nuance, and about them and all that. And so, graduated from residency, took a job at a community health center there worked as an attending physician at one of our local hospitals, then moved to San Diego about, wow, has it already been 16 years now? Yeah, I've been at La Maestra for 16 years, time does fly. And in 2012, I became a medical director. And then a few years ago, I became the company's first chief medical officer.

SARAH: Thank you both for sharing your journey to where you are now. Zara, so we could spend many episodes talking about the 30 plus years that you've led La Maestra and the extensive range of care that the organization provides. For purposes of this episode, we're really going to focus in on those housing needs. The wide range of housing needs that La Maestra helps meet in San Diego. We mentioned a few of them at the top of the show. Can you just give us a rundown on some of those initiatives? What you have in place to address needs like affordable housing, transitional housing, counseling for renters and homeowners. It really is wide-ranging.

ZARA: Yes, it is very wide-ranging. Our communities have a lot of needs around housing because San Diego is known for of course being a beautiful city, but there's a huge lack of housing that's affordable and safe. And the prices for rent is very high. And so it's always challenging for people to, to find their own home, right or to rent. And so that results in families sharing a one-bedroom, two-bedroom apartment. And that gets us into the environmental health of living in substandard housing where it's overcrowded, there's not enough air ventilation and crime.

But some of the initiatives that we've been involved in around housing of course, the first is, what connection does housing have on health and the quality of your life? And that leads us to looking at the family unit, right? And seeing not only where families live, but where do kids have access to being able to be outside in a safe environment, exercising, and enjoying what kids should be doing, right? So we look at all of that, plus, how to prevent chronic disease in residents of low-income housing, and in our communities that we serve.

We know that residents of public housing, affordable housing have complexities of needs and health care services is one. Then you have the social determinants, like, are they getting enough food? Do the kids have a place that will help them with their homework or someplace to go after school? And then you get into more of the social services needs around, you know, food scarcity, human trafficking, domestic violence and many of those challenges. Aside from dealing with people that have come from other countries, immigrants, refugees. That's one of La Maestra’s niches and being able to know what it is that those residents need comes through our cultural liaisons. These are staff that are medically trained from the populations we work with. So they're linguistically competent, culturally competent, and they have shared backgrounds, which builds that trust with the public housing residents.

So what we've done is we've had several programs that actually go into the home for assessments, environmental assessments, like the asthma mitigation program. And that takes us into the home identifies the triggers of asthma and so forth. And, you know, what does that have to do with where they're living? So that's one way that that we can actually help people by going into their homes.

With seniors, we have a similar program where we go there and we see, what is it their housing situation and how is that affecting their health or their mental health, their well-being? How is that causing them to stress and anxiety? And how does that impact their health?

We have recently worked with, especially around COVID, of course, you know, talking about COVID doing outreach into these housing units. We work with the managers there, when there are multiple housing units, obviously, to bring in health education sessions, outreach sessions, and being able just to share with the residents, Look, there are resources out there we can help you with, for example, especially during COVID, the rent deferral, the when, you know, people weren't working, and they didn't, they couldn't pay their rent and how to apply so that they don't get evicted from their home. Also, helping qualified residents be able to get assistance with any back rent that they owe, utilities that they owe, getting them help with security deposits, if they need to move, and a lot of times they need to move because, the dwelling is full of these triggers of asthma, or there's high crime and environmentally, it's not a good deal for them. So that program really has helped a lot.

Aside from that, we have you know, partnered with the Housing Commission and affordable housing to provide you know, joint events where we'll bring our mobile clinic out where a lot of people live, for example, lots of apartments, or in the park nearby. And we'll partner on how do we get those resources of information on what people can be eligible for, to kind of connect them into our Circle of Care, and be able then to have them access the services that they need through the pathways that we've established either through La Maestra or through one of our partners.

SARAH: So yeah, housing is health in so many different ways.

Javier, as the Chief Medical Officer for La Maestra, can you share with us how you train your team of medical assistants, nurses, physicians and other providers to address housing needs? And, you know, what does that training look like? And what might some of those conversations be with patients?

JAVIER: That is a very important question or set of questions, if you will. But I think a lot of times, it starts from the actual interviewing process. We hire staff from the community that can empathize and have lived through some of the issues that a lot of our patients have already gone through, are going through. So we definitely value our interview process and keep that in high regard, especially to vet out, even now, during times of staff shortages, because of COVID, and what have you. But we also value and pride ourselves that visits to the clinic aren't only about the actual provider visit, you know, the needs of our patients are way more than that of a 15 to 20 or 30 minute visit could provide. That's why we train in our workflows, that staff understand our social determinants screens, in terms of increasing that awareness, especially with providers. A lot of times providers are just so busy, that they sometimes don't always necessarily get that. But the nurses though, they're positioned in key spots, where during a patient triage, you know, why is the patient having problems with diabetes symptoms, or having a lot of respiratory symptoms? Because maybe they got homeless, because the definition of homeless is pretty broad. I mean, it doesn't have to be that, you know, you're homeless in the typical sense, where people are, panhandling, what have you. But anyone that, really doesn't even have a renters agreement, you know, move from place to place.

Maybe they forgot their meds, they lost their meds, or, you know, in more severe cases, things were stolen from them, you know, like, in homeless populations. I mean, I know, my brother-in-law is homeless, you know, and he doesn't want to get the help as much as we try to get them to help, you know, and, you know, he was recently, you know, got stuff stolen from him beat up, you know, and stuff like that. So, those kinds of things, the nurses are there triaging, getting a lot of this social determinant information and so I think our nurses that, you know, they go over this information they share our outreach team brings us the latest information of what's going on, who do we have, who can we connect with them in terms of like, you know, for shelter placement, if it's needed, and urgently and what have you. So a lot of the times like, you know, the nurses are the ones that have been key in this.

Other conversations that we've had with patients, like Zara was mentioning about the allergen burden and in the home, and with the impact of, you know, the environment, whether it be mold, whether it be dust mite, whether it be cockroaches, We're able to get lab panels of things that, you know, they're very common in terms of allergen burden and oftentimes, you know, the families need that old carpet to be removed, so we try to be a mediator with the landlords and then the different property management companies. We’ll write a letter for a patient saying, hey, they have this diagnosis, these are the lab results. Patients give us permission to share them with you, could you please consider changing out this old carpet? Could you please consider putting in a laminated flooring instead, you know, more inexpensive option than hardwood?

And so a lot of times we find ourselves advocating for patients in that way. So, those are some of the conversations that we have, you know with our patients and everyone's aware of this. because we all talk, we have department meetings, we have staff meetings, you know, we share via email, by text, whatever it is, you know, we do have these conversations, we're like, Hey, this is what's going on, this is where we can get different help patient navigation, and different resources, especially when it comes to housing or any of the other social determinants.

SARAH: You're clearly providing care, within the clinic, outside of the clinic, and in a lot of different levels. You know, looking more broadly, I would imagine a lot of this is happening at the systems level. So Zara, I'm wondering given La Maestra’s experience, can you share what it's taken for the organization to build relationships with the San Diego housing authority over the years? And, you know, even sort of how you build capacity to navigate some of these complex interventions?

ZARA: You know, I think that one of the strengths that our organization is that we have built these relationships, partnerships, collaborations across different sectors for over 30 years. And so if we just look at, you know, the, you know, the Housing Commission, we can see that when we partner together, then they reach out to all of their residents.

Just makes our job a lot easier if they can then share the resources that we have. You know, whether it's flyers, notifications, events that we're going to be holding, or letting them know that we're going to be coming out to the units to do health education, or talking about COVID. And so how do you get that information out right away? You go through your partners in your network of collaboratives. And the Housing Commission was one. Another example is the lead blood testing that we partnered with the Housing Commission and the city of San Diego. First, it was doing a lot of outreach, health education with our communities, about where lead content is higher that is found, for example, and put up posters, and talk to the community about that, and then actually do the testing for kids. And then working with the city to locate those parks in San Diego, that the city, you know, basically took old gas stations and put a park on top of it, without really cleaning the soil, and polluting the area. So then they needed a clinic to go out and do the testing. We were that clinic. So we have a long history of working with the community working with the structures and the powers that be. So it's either, you know, your local government, federal government, state government, and other organizations that are working with the community in the community, and then doing what we can from La Maestra and within La Maestra as well.

SARAH: What would you say are some lessons that you learned or things that you would want our listeners to take away, when it comes to building those community partnerships when it comes to thinking about housing and health, some of the things that we're talking about.

ZARA: I would say that being informed and knowing what resources are available within the community, is really important. Because that's how you start knowing which organizations you should start collaborating with, right. And so knowing what's available, and then working within your organization to perhaps develop those MOUs with different organizations that work with housing, or economic development, food scarcity, and so forth.  And we know that many organizations perhaps, you know, they might advertise on the computer that, you know, or through Google, that they have, you know, expertise in housing, but maybe they don't have the capacity. So that's why the memorandum of understanding I think is really important. We've learned that firsthand, because the last thing we want to do is refer patients, you know, social prescribing to organizations that don't have the capacity, or perhaps our patients won't meet their eligibility. So that's up to us to figure out. We don't want to add more burden to already challenging situations for our patients. So that's one of the lessons learned that you know, we really do have MOUs in place across sectors and that way everybody understands.

JAVIER: I can add a little bit as well. Again, it goes back, to who we attract, and who we hire and our interview process, what have you. Because you have to realize that traditional nurse training programs are preparing them for the inpatient world.

We always have to keep that at the forefront that traditional nurse training is geared for inpatient care, which is a very, very, very different world from community health care nursing. So we're always mindful of that, you know, when we're hiring, or when we're speaking to potential candidates, and then we're letting them know, upfront, this is community health care nursing. Yes, there is triaging and there is clinical. There are some procedures, injections, what have you. But a lot of it has to do with, again, back to our social determinants, finding out what's going on with the patient from that level, and others too. So I just wanted to mention that, because that's a really huge point. And that's why sometimes, you know, we have to be very particular, in terms of who we hire, but also who we attract to, and, as this pandemic has shown, and with a lot of the different things that have happened at the hospitals, and a lot of the media attention is at the hospitals. And, you know, a lot of the burnout, you know, nurses have been getting burned out, working inpatient. And I know, sometimes they don't feel appreciated, especially now with a lot of the anti-vaxxer commentary and what have you. So, and even with mandates coming up to that's the other side of you know, that coin, because it's not a cookie-cutter approach, or a one size fits all. So we try to be very mindful of these things, when we're hiring and when we're training and when we're working with our staff.

SARAH: And I really appreciate you highlighting how important it is to be thinking about who you're hiring. It's not just about training, it really is both and we talk about that a lot in terms of diversifying the nursing workforce and the future of nursing. For our listeners who've been keeping up, The Future of Nursing Report certainly highlights the need for nurses in community-based settings and community health and public health. And for that to be a diverse and culturally competent workforce. But if we could talk for a moment about the specialized residential programs and in particular, about the housing for individuals who've experienced human trafficking. So Zara, could you tell us a little bit about how La Maestra got involved in that effort and how the program works?

ZARA: One of our programs that we've had since the beginning of La Maestra amnesty center in 1986, has been our immigration unit. And we rely a lot on our attorneys that can help people who have special conditions that are meant to apply for residency status. And that in and of itself is big complexity, right. And so I belonged to a bilateral safety corridor coalition for five years. And then it was like, they asked me to come because they didn't have any health care provider that would come to these meetings, and that would take their clients. So they had human traffic clients, but they weren't finding success and being able to refer their clients to other health centers, because keep in mind, the clients did not have any form of payment. And they weren't eligible to apply for MEDI CAL or any assistance programs because they lacked legal status. So you know, I got permission from the board and we started, we actually funded it, this program, so we could take the referrals, and then meeting with the other law enforcement agencies, and then going with our staff on the sting operations. So whether the person had been sex trafficked, or, you know, labor trafficked, we would have the ability to, and we still do, be able to refer them to shelters, work with those shelters, get them the emergency phone, what do you do with the kids? Meanwhile, provide all of their medical and mental health counseling needs, and help them work through the process of their immigration application. So whether they're applying for the U visa, the TVisa, so which is the human trafficking, domestic violence, or their political asylum, we grew all of these areas of expertise. And again, what we can't handle, we have partners that we work with through these MOUs so we could refer our clients there. And that's how we got involved. This was, you know, I want to say three years ago, and so that's why we've grown our own legal advocacy services immigration unit, we've continued to grow since 1986. And we have the human trafficking assistance program. We're the only FQHC agency here in San Diego, that contracts with USCRI in Washington, DC, specifically around the needs of human traffic victims.

SARAH: And you mentioned that that was self-funded at this point, are other entities supporting the work? Or how is how are you continuing to do the work?

ZARA: What we receive now are small grants from private foundations, you know, maybe 5000, here or 3000, there. But our goal is to really be able to take care of this subset of our community, you know, our clients. Because we're on the border, right. And, this need has greatly increased with all of the activity across the border, right. And so that's just being able to step up and draw on those resources and using our operational budget, until these clients then can apply for their legal status under one of these programs, under immigration, and then they would be able to apply for assistance. It’s just helping them get connected.

SARAH: That's really remarkable. And definitely truly community-driven, right, being responsive to the needs that are arising. Javier, is there anything you wanted to add on that related to that program?

JAVIER: Oh, yeah, definitely. You know, Zara is wonderful, and she's awesome. She's my mentor, and I just really want to give her the shout out right here that she has always deserved, you know, for this.

But we also have assistance with shelter and transitional placements, you know, those needing immediate assistance like I mentioned earlier, as well as those that reentering from custody. And then we also have you know, collaborations for sobriety and housing, we work with faith-based organizations that take individuals and families. And these are the ones that are that are heavily used by our behavioral health unit or a certified community behavioral behavioral health center. And who is led by our providers and we also have a nurse there, so that they can tag team, a lot of these, these tough situations that our patients and their families go through.

SARAH: And so recognizing how so much of your work is intersecting with these social factors, and we know that there are massive systems, right, that are creating the social determinants that unfortunately, many of our clients and patients are experiencing. So how do you get involved, you know, politically or from a systems perspective, from an advocacy perspective? Do you have ways to encourage you know, nurses and other health care providers to speak out? How does that relate to their practice?

ZARA: As a grassroots organization, La Maestra has always taken a strong advocacy role to speak on behalf of those, you know, populations that don't have a voice because they're not at the table. And so we've always taken that position and aligned ourselves with consortia collaboratives, at the local, statewide federal level, around all of these issues. So if it's health, for example, the healthcare sector, we have our collaboratives around the medical field. Same thing with human trafficking, housing. And we participate always. We always are providing podcasts, speaking nationwide on these panels around special populations, for example. And it's, that is a wonderful opportunity for our staff also to get involved at every level. We also have press conferences, where recently for example, the mayor of San Diego, the supervisor of the board of directors at the county came out to La Maestra because we're launching 21 new units of transitional housing. And that's something that, you know, our staff participated in, because we invited them, they were at the, they spoke with the different media that were that were present in different languages, by the way, to not only highlight the need for more housing, but you know, talk about, okay, these are new units that we're developing through this partnership with the city and the county of San Diego, who also recognizes that housing is a huge issue for San Diego. So these kinds of events, we're always working on something and our staff has plenty of opportunity to participate with us.

SARAH: It sounds like you have a very collaborative practice environment. I would love to hear about how the cultural liaisons interface with nurses, medical assistants, nurse practitioners, you know, how does everyone work together? What does that look like?

ZARA: La Maestra early on, developed a cultural liaison model. And what this means is, we identified people that were from our different, culturally diverse populations. And worked with them to train them on a to work in a medical position. So it could be in referrals or case management, or how do you become an MA, medical assistant. And some have gone even higher to become nurse practitioners or marriage and family therapists. And it's how do you grow your community? How do you create those opportunities, because after all, that's the best match for our patients, right. And so these cultural liaisons, we have, I think, 30 of them across all these different languages, of course, they come from the same challenges, backgrounds of trauma, that their populations that they live with, right their community, and their churches, their faith-based organizations. They are not only imparting the information that our providers and our clinic is trying to relay to the patient, right, in their language, but they also educate us and they educate the providers and the educate, you know, the administrators, the managers, or directors about what their specific population needs.

For example, a new Syrians that came in or now we have the Afghani. Before that were the Cubans, the Haitians. You know, before that were the Somali, the Sudanese, Laotian, Vietnamese, all of those populations, we need people that are going to work from within those communities, and be that conduit, right?

And that's how we can tailor the message for our health education. That's how we tailor how do we deliver this message? What's more culturally sensitive, like around breast cancer, right? Well, some cultures didn't want to be shown diagrams in a group of the breast, it wasn't appropriate for them. So we developed other ways to share the material, other venues right. And again, working with the leaders of those communities. And the cultural liaisons are extremely important, not just out in the community, working with outreach, health, education, and so forth, but also being able to work within our facility. And when patients show up, they already know the patients because they may help them make the appointments. They help refer them to the eligibility, they are going to case manage them, they're going to deal with these other issues that the patients are going to confide in them, right. And so they're very much part of that clinical staff team. And a lot of them work right under the nursing staff, and with the nursing staff. In fact, they will be the ones to probably come out and say, You know what? This family has been living in their car for six months. That's why the kids have been to the emergency room with their uncontrolled asthma. But see, how else would we be getting this information, when you know, patients show up, they're not going to just open up and say, you know, this is why I was living in my car. This is what happened to me. They have to have that trust relationship first. So we've always maintained this cultural liaison model throughout all of our programs.

JAVIER: I always explain to others, and new staff coming on board that they're like a bridge. They're like a bridge to so many different things. Whether it be language, whether it be cultural, whether it be financial, whether it be even religious.

We recognize that, yes, I'm culturally competent, and I'm even, bilingual, I still need that help, I still need that extra understanding. I still need that extra clarity from a cultural side. So that they understand what the health care team are thinking, but even further beyond that, what the community's thinking, what is the healthcare establishment is thinking, because there's some huge disconnects there. And so the cultural liaisons help us to help them in that area.

ZARA: The cultural liaisons also follow the patient, when they go to the emergency room, or if they are in a scheduled operation, they will be there because we know that many times the hospitals are not going to have that same level a navigator that goes with you, and helps you navigate through their incredible systems. So the cultural liaisons are awesome, not just within our organization, but they go along these pathways to link to the outside resources that we refer people to.

SARAH: We're nearing the end here. So I want to just sort of open it up if you have any final words on that you would want to share or to close out maybe talk about you know what you see for the future of La Maestra, what you would love to see?

JAVIER: We definitely want to keep growing and taking our teams to the next level. We have to always realize that, yeah, we're in a good spot right now. But we can get complacent. We can get super comfortable. We got to continue to see what the needs are and continue to grow around that. And that includes not just administrators but even includes providers, nurses, MAs, checkout PSRs, everybody, I mean, really, I mean people that come to work at La Maestra, and it doesn't even have to be clinical. They know what we're about, what our niche is and what have you. So we got to continue to portray that and you know, in promulgate that.

ZARA: Yes, I wanted to add on that. The other lesson learned, of course, for us is that it's not just about the organizational fit. It's the orientation that new staff are provided on all of these services around our Circle of Care and how we know what strategies have we employed and want to expand on that integrate those services? So that the staff know what resources there are within La Maestra? What kind of partners we have across what sectors? And so they already are starting with that information. And then they can figure out okay, so who do I ask if I have a patient that has a problem with their housing, okay, we have the housing navigators. We have the cultural liaisons, we have the case managers, the core of the care coordinators, eligibility and so forth. But it's really important for us to keep stressing that. And Dr. Rodriguez does great in his provider meetings, you know, with the providers, all levels of providers and the nursing staff, to be a reminder and also to be able to talk about new trends that we're seeing in terms of needs. And new partners we have, that's really been very important.

In terms of housing, we of course, want to continue the housing navigation, working with all sectors of housing, transitional housing, which we have already since 2010, grow that. Grow other shelters, perhaps there's not enough shelters in San Diego. And as we continue to work with the homeless population, we're also certified under the HRSA, you know, 330, FQHC designated as a homeless clinic as well. So we have a lot of programs that we partner with other entities that go out to the different homeless camps with our mobile clinics. That's another population and with the re-entry population that Dr. Rodriguez mentioned, that also needs housing, right? Housing connected to transitional housing perhaps, and, and connecting them into that support system, which I think is really important. La Maestra is more than just a community-based organization. I believe it's really an agent of change. You know, if you figure the volume of people that go through there, and the advocacy that we have, and our ability to reach so many people, we definitely are an agent of change. And we're a support system to so many people. It's not like they just come for one visit, and they're gone. Most of our patients have access at least five or six services around our Circle of Care, you know, different sectors. And they'll just stay with us, you know, whether it was they're coming back for dental or now they're volunteering, they're part of an advocacy group. It's really awesome. So integrated care is the future and hopefully, we see the federal government providing more reimbursement for the social determinants.

SARAH: So thank you so much for all that you do and for making time to join us for this podcast.

ZARA: Oh, thank you. It was a real pleasure. Thank you.

JAVIER: Thanks for having us once again.

CREDITS

SARAH: Funding for our special Housing is Health series comes from the Center to Champion Nursing in America, which is a joint initiative of the Robert Wood Johnson Foundation, AARP, and AARP Foundation. Special thanks to our partners through the National Training and Technical Assistance Program at the National Nurse-Led Care Consortium.

For more about us and our programs, log onto  paactioncoalition.org and nurseledcare.org.  And you can connect with us on social media @PaAction and @NurseLedCare. 

At the Core of Care is produced by Stephanie Marudas and Emily Previti of Kouvenda Media and mixed by Brad Linder.

I'm Sarah Hexem Hubbard of the Pennsylvania Action Coalition. Thanks for joining us.

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