Dartmouth Health secures legal aid for patients experiencing health disparities

Dartmouth Hitchcock Medical Center

Photo: Courtesy Dartmouth Hitchcock Medical Center

A hospital system in New Hampshire has been awarded two years of funding to provide legal services for patients experiencing health disparities.

Dartmouth Health, which includes its flagship hospital and academic health system Dartmouth-Hitchcock Medical Center, has a medical-legal partnership focused on identifying health disparities in communities and addressing individuals' unmet legal needs related to social conditions, the physical environment or inadequate knowledge of or access to available public benefits. 

Launched in 2021, families eligible for this program must be pregnant or have at least one child under the age of five. 

Dartmouth Health announced it has been awarded another two years of funding, following a successful first two years, with the New Hampshire Charitable Foundation and the Couch Family Foundation again financially sustaining the program.

WHY THIS MATTERS

The program helps address health and social needs, such as ensuring emergency access to insurance benefits, preventing employment and education discrimination and securing housing and preventing unwarranted and illegal evictions. 

There's a large portion of people who need legal intervention who can't afford it, according to Holly A. Gaspar, manager of Dartmouth Health's department of Population Health and medical-legal partnership program manager. 

"This is really about equity for the population," Gaspar said.

Some individuals have a sense of fear about the legal and health systems if they've had negative or poor experiences. 

"We're able to show collaboration and support across the system," Gaspar said. "This is one additional way to show how we can do that through a health system collaboratively."

One big issue in this Upper Valley region of New Hampshire is the lack of housing. Regional planning commissions estimate that 10,000 new homes will be needed by 2030 to meet demand for shelter in the Upper Valley, according to NH Business Review.

Dartmouth Health recently announced an additional $2 million investment in the New Hampshire Community Loan Fund to support affordable and safe housing, according to WCAX.

Beyond housing needs, Gaspar said Dartmouth Health has seen a large swath of wrongful evictions - some due to substance use disorder - and inhabitable housing conditions caused by bed bugs, lead, lack of heat, mold and other issues. 

"It takes intervention from a legal team to have these needs met," Gaspar said. 

Sometimes patients are living with these conditions for months, but when the legal team sends out this "very lawyerly letter, within 24 hours someone is there to do the mitigation," she said.

When basic needs such as housing are met, people are better able to take care of their own health, Gaspar said. 

The program is too new for Dartmouth Health to have numbers on how legal intervention has helped stem readmission rates or ER visits, but it's already well known that care must extend beyond the walls of the hospital to treat the whole person, Gasper said.

Dartmouth Health has helped 107 individuals and by extension their families  - over 200 children under the age of 18 - through the medical-legal partnership.

Gaspar estimates the cost to be about $125,000 per year.

"We are starting to look at expansion," Gaspar said, "looking at other investors."

THE LARGER TREND

Health systems nationwide have done much to address the social determinants. Montefiore in New York, for example, invested in housing and realized 300% ROI. Northwell launched a food insecurity program and other hospitals have opened grocery stores, especially in urban areas, for access to healthy food.

But having a law program in place to address health disparities is fairly new, at least in northern New England, according to Gaspar. 

Five to ten years ago there were a handful of hospitals nationwide that were participating, she said. Now there are over 300, with models seen in Massachusetts and Connecticut.

This effort is a partnership between Dartmouth Health and New Hampshire Legal Assistance.

"Medical-legal partnership is a win-win," said Sarah Mattson Dustin, executive director of NHLA. "Our healthcare and community partners receive the benefit of dedicated, on-site legal services for the families they are serving, and the innovative model brings NHLA even closer to our clients and communities."

Dartmouth Health includes Dartmouth-Hitchcock, Dartmouth Cancer Center, Dartmouth Health Children's, Visiting Nurse and Hospice for Vermont and New Hampshire and more than 24 clinics that provide ambulatory and specialty services across New Hampshire and Vermont. 

Email the writer: SMorse@himss.org