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A partnership between The Brookline Center and Soldier On, a Massachusetts nonprofit that provides transitional housing and services for homeless veterans, is helping former servicemembers across the state manage their health more effectively.  

The project brings the Center’s Healthy Lives program to veterans facing multiple mental health and medical challenges, pairing them with registered nurses and case managers who integrate services, help manage illnesses, and offer guidance and coaching. The approach leads to measurable improvements in treatment adherence and a decrease in the use of emergency services, ultimately resulting in better health outcomes and reduced healthcare costs. In addition to serving veterans, Healthy Lives works with Blue Cross Blue Shield of Massachusetts to identify and support BCBS members with complex medical conditions and at least one mental health diagnosis. 

Spending extended time with clients during house visits is a crucial factor in building the deep interpersonal relationships that are at the core of the program. “I get to see the whole picture of a client in a way that you can’t from a 15-minute office visit,” says Healthy Lives Program Manager Lori de Paiva, LPN. 

According to de Paiva, educating patients and supporting them in making small changes can lead to a significant—and often immediate—impact. She recalls helping relieve a client’s chronic pain simply by noticing that he had an unfilled prescription for a medication in his medical paperwork. Another time, she helped a veteran transition from using a wheelchair to walking by working with his insurance to cover leg braces. “Little steps add up to something big,” she says. “These individuals have sacrificed a lot for our country, and they deserve all the support we can provide.”