Outreach Chronic Care Nursing

Health Services Building
Weekdays, 8:00 a.m. to 5:00 p.m.
Phone: 518-358-3141

On-call for current Outreach patients

  • Monday to Thursdays 5:00 p.m. - 8:00 a.m.
  • Friday 5:00 p.m. to Monday 8:00 a.m.

Mission: To provide quality professional healthcare with dignity and privacy within the scope of our work.

Services Offered:

Home Health Aide Services

  • Home Health Aides assist patients who have a care plan with activities of daily living such as personal hygiene, light housekeeping, taking vital signs, medication reminders and daily exercise for their clients. Home Health Aide services are supervised by a Licensed Nurse.

Foot Care

  • Our nurses offer education about proper foot care for diabetic patients or patients with peripheral vascular diseases. Outreach offers weekly foot care clinics. For questions on proper diabetic foot care contact the Outreach Department.

Medical Transportation

  • Medical transportation is offered to eligible patients who don’t have access to transportation to and from their medical appointments. The Transportation Coordinator needs at least one week’s notice for a patient to receive transportation. For more information you can contact Lynne Thompson, Transportation Coordinator.

Smoking Cessation

  • The Outreach Tobacco Cessation Specialist offers tobacco cessation, counseling and support to patients who are interested in quitting.

Provider Ordered and/or Group Screenings

  • Provides scheduled screenings in the community for diabetes, hypertension, cancer, immunizations and makes appropriate referrals as needed

Wound Care

  • Certified Wound Care Nurses provide excellent care to patients with hard to heal wounds. If you have a wound that just will not heal please contact the Outreach Department and make an appointment for an evaluation.

Car Seat Installations and Safety

  • Outreach has two Certified Car Seat Technicians who educate on how to properly install a car seat in a vehicle. New car seats are available one per child, per family. For questions about car seat safety, please contact the Outreach Department.

Home Safety Checks


  • The Immunization Coordinator educates the community on the importance of receiving all immunizations for disease prevention. The Coordinator also maintains the immunization registry, tracks and recalls all patients behind with immunizations and reports to state, federal and tribal agencies.

Environmental Assessments

Food and Safety Inspections

Case Management & Discharge Planning

Health & Wellness Screening Days

On-call 24/7 for Home Care Patients only

CPR and First Aid for SRMHS Employees

Falls Prevention Program

Continuous Glucose Monitoring (CGMs)

Patient Navigator for Chronic Diseases

Provides prevention and chronic nursing care to the community of Akwesasne

Accepts referrals from surrounding hospitals and medical providers

Assesses the patient to meet their specific needs

Offers medical transportation to appointments for eligible patients

Networks with local health agencies and medical providers to provide optimum care for our patients