At Tracy Community Connections Center (TCCC), we focus on long-term solutions, and one of the most effective tools we have is case management.
Case management is at the heart of how people experiencing homelessness or housing insecurity get from surviving to rebuilding. Without it, even the best intentions fall flat. You can hand someone a meal or a blanket, but if they don’t know where they’re sleeping tomorrow, or how to get ID, or access medical care, they’re stuck in survival mode. Our case managers help people move forward.
More Than a Referral
A case manager isn’t just someone who gives out a list of phone numbers. At TCCC, our case managers get to know each client, including what they’ve been through, what they need, and what obstacles are in the way. Then we create a real plan with goals, support, and follow-through.
We don’t expect someone in crisis to navigate ten agencies, five forms of ID, and hours of red tape. That’s how we help. We help clients make it to appointments, fill out applications, advocate for them when systems are hard to navigate, and check in regularly. Progress is tracked. Barriers are addressed. No one has to do it alone.
Stability Beyond Handouts
Giving someone a tent or a hygiene kit feels good and helps in the short-term, but if you want to see lasting change, we need to address the root causes of housing insecurity: trauma, unemployment, eviction, illness, addiction. These don’t get solved with quick fixes. Case management provides someone in your corner that you can trust, with the time and experience to help.
Our case managers connect people to housing programs, job resources, health services, legal aid, or whatever it takes. And because TCCC has long-standing relationships with our clients, we can spot changes early and pivot when needed.
We sit down with every client and hear their story. Our case managers work with them to identify their barriers to housing – whether that be employment, mental health, or addiction. Then, the case managers will work side by side with the client to create a housing plan by addressing these barriers. They meet with the client regularly and identify what programs or funding we have that could address the barriers, and refer out to other agencies for needs we cannot meet. Our case managers work with our street outreach team to coordinate services in real time like transportation, getting prescriptions, or getting into the city shelter. TCCC also offers bilingual Spanish-speaking case management for those who need it.
Funding Case Management
We have seen the positive impact of case management for unhoused individuals and we know that it works. The way to make it even more effective is with funding, staff, and more community awareness. Case management is slow, gritty, behind-the-scenes work but it’s what moves people from the streets to stability.
If you want to make a real difference in Tracy, support organizations like ours offering long-term case management by donating or volunteering. And if you or someone you know is stuck, please reach out.
At Tracy Community Connections Center (TCCC), we understand that healthcare doesn’t end at the hospital door. Many homeless individuals rely on the ER for basic medical care, only to face additional challenges once discharged. That’s why we’ve partnered with social workers at Sutter Hospital in Tracy to create a vital post-hospital care program, designed to support our most vulnerable neighbors and ease the burden on emergency services.
Addressing the Challenge of Post-Hospital Care
For homeless individuals, the transition from hospital to community can be daunting. Without a safe place to go, access to food, clothing, or even follow-up care, patients are at high risk of readmission. This cycle not only jeopardizes their well-being but also leads to increased healthcare costs and strain on emergency services. TCCC’s innovative approach tackles these challenges head-on, offering both short-term relief and long-term solutions.
How Our Program Works
Through our collaborative efforts with Sutter Hospital’s social workers, we ensure that qualifying individuals discharged from the ER in Tracy receive comprehensive support:
Safe Discharge
We develop a discharge plan for each client which may include emergency motel housing at the doctor’s discretion. Our team will work with the social workers, doctors, and the client to connect them to a primary care physician, coordinate case management, and develop a long-term housing solution.
Essential Supplies
We ensure that every client receives what they need, including discharge instructions, medications, clothing, and food.
Daily Support
Recognizing that recovery is a process, our team checks in on each client daily, offering ongoing case management and assistance – tailored to help them secure longer-term, stable housing.
Coordinated Care
We meet bi-weekly, or more frequently, with Sutter Hospital social workers to discuss each case and continuously improve the quality of care. This coordinated effort helps prevent readmissions and supports sustainable recovery.
Impact and Importance
In 2024 alone, our post-hospital care program helped 74 clients. Each of these individuals received not just immediate relief, but a pathway toward a more stable future. By providing comprehensive support right after hospital discharge, we:
Care for Individuals
Our program addresses the immediate needs of those transitioning from critical care, ensuring they have a safe environment to continue their recovery.
Prevent Readmissions
With proper follow-up care and daily check-ins, we reduce the likelihood of complications that can lead to re-hospitalization.
Reduce Healthcare Costs
By keeping individuals out of the ER and hospital, we help lower the overall healthcare costs associated with chronic, unmanaged conditions.
Break the Cycle
Ultimately, our approach not only supports immediate recovery but also paves the way for long-term stability and independence, breaking the cycle of homelessness and repeated ER visits.
Join Us in Making a Difference
The work we do at TCCC is driven by a simple belief: everyone deserves a safe, supportive environment to heal and thrive. Through our post-hospital care program, we are not only helping individuals recover but also contributing to a healthier, more compassionate community in Tracy.
If you’re interested in learning more about our program, volunteering, or supporting our mission, please get in touch. Together, we can build a community where everyone has the opportunity to reclaim their health and hope.
