Homelessness and Healthcare Week

To contrast in a really humbling way with my previous post...

Several of my amazing friends here at Emory have spent a lot of time and energy organizing the second annual Homelessness and Healthcare week, with several speakers, a film, and a panel discussion that have all been excellent.  I meant to write about this earlier in the week in case anyone reading this is in the Emory/Atlanta area and had any interest in these subjects.  The last event is tomorrow, and the speaker will be giving a talk on How To Navigate the Grady System.  Some can appreciate this more than others, but if you have ever had personal experience with medical/hospital/insurance/social support program bureaucracy or know anyone who has (and we all do, whether or not we realize it), then you have some idea of what a nightmare it can be.  

I really think that complicated, confusing, redundant, inefficient Systems and the Paperwork they entail are just as large barriers to care than not having access at all.  Because what good is so-called "access" when navigating the system practically requires a social work degree, a law degree, hardball negotiation skills, fluency in multiple languages, and years of experience?

Anyway, the talk tomorrow is at noon, in the School of Medicine building, room 110.  It is free and there will be lunch provided.

Jake's organization, Community Solutions, posted a great article related to this issue on their blog recently.  It helps flesh out the link between homelessness and poor health, and the obvious advantage of providing better transition or recuperative care to patients who have no home to which they can safely be discharged for hospitals, communities, and taxpayers as well as individuals experiencing homelessness.  Seems like a pretty clear win-win-win-win to me... why isn't this happening more and what can we do about it?

Recuperative Care: Better Care at Lower Costs
by Catherine Craig  

Homelessness can make people sick. Really sick. 

Among over 20,000 homeless people surveyed nationally through our 100,000 Homes Campaign, more than one in five lives with a chronic health condition alongside a substance addiction and a mental health condition. These co-occurring conditions are often exacerbated by the harsh realities of life on the streets. Addressing them requires a coordinated approach to care. 

Last week, writing in the Los Angeles Times, Anna Gorman highlighted a promising strategy: medical respite programs, also referred to as recuperative care.

The National Health Care for the Homeless Council defines recuperative care as "acute and post-acute medical care for homeless persons who are too ill or frail to recover from a physical illness or injury on the streets but who are not ill enough to be hospitalized." In other words, it’s a transitional alternative to a hospital bed where a homeless person can heal after a hospitalization or medical emergency. The goal is to facilitate a process of healthy recovery that homelessness often impedes or prevents, and to do it at lower cost than hospital care. 

Gorman is based in Los Angeles, where some very innovative work on recuperative care is taking place under the leadership of Dr. Mitchell Katz at the Los Angeles County Department of Health Services. The experience of Dr. Katz and others confirms that recuperative care programs are a proven strategy in reducing readmissions to hospitals and in driving down unnecessary health care costs. A recent study found that readmissions within 90 days of recuperative care dropped by 50 percent. It also found that such programs could help hospitals and communities save as much as $6 million per community annually. Since many of the sickest people on the streets are eligible for Medicaid, recuperative care typically translates to direct savings at the state and federal levels. Even among the unenrolled, it frees up money within hospital charity budgets that would otherwise have funded the repeat hospitalization of homeless individuals. 

So if recuperative care is such a win/win strategy, why have so few communities chosen to implement it? Despite its demonstrated effectiveness as a cost saving approach, the truth is that recuperative care remains very difficult to fund. Today, most programs rely on small foundation grants or tenuous local funding. 

To save money and improve health outcomes, we must find sustainable ways to pay for recuperative care. 

Luckily, this imperative is also timely. The new health care reform law places a large emphasis on coordinated care and lowered hospital readmissions, both of which reduce costs to the system. With Washington working to ensure better care at lower cost, now is the right moment to leverage Medicaid funds to pay for the broad adoption of the recuperative care model. Doing so will improve health outcomes for homeless people and reduce the burden they place on the public purse. It could also help many find permanent housing. 

But the benefits don’t end there.  A respite care stay lends the opportunity for long-term homeless people to connect with case managers and begin developing a pathway off the streets.  Depending on an individual’s circumstances and length of stay, it has even been possible in some communities to discharge homeless people from recuperative care directly to the safety of their own permanent apartment. 

Recuperative care does not always result in permanent housing, but it has huge potential to help. As communities bring together key players from all sectors in an effort to simplify their housing placement systems and make housing available to their sickest homeless residents, recuperative care facilities can and should have a place at the table. With careful planning, these sites, along with hospitals, can serve as alternative intake centers for the housing process, using the arrival of new homeless patients as an opportunity to link some of the costliest and most vulnerable people to effective, low-cost care, and then to homes and ongoing support. 

Additionally, while most communities view recuperative care as a transitional step down from the hospital, communities like Boston have also utilized it as a step up from permanent supportive housing for patients in crisis. Pioneers like Dr. Jim O’Connell at Boston Health Care for the Homeless have successfully refashioned recuperative care as a therapeutic intervention to prevent the unnecessary hospitalization of formerly homeless people in crisis. O’Connell and his colleagues have found that this small amount of extra support can stave off costlier and more severe health emergencies while returning patients to permanent housing more quickly. 

For more information on recuperative care, or to find a recuperative care provider in your community, visit the National Health Care for the Homeless Council’s Respite Care Network.