Various groups, clinics and organizations have set up places for the homeless to recover from injuries, surgeries and serious illnesses.
eEarlier this year, a homeless woman in her 40s who had been living in her car visited the emergency department of a hospital in Orange County, California. It turns out she has stage 2 ovarian cancer. She did not have a home to return to when she was discharged from the hospital, so her hospital referred her to her non-profit housing organization, The Illumination Foundation.
Foundation staff assessed the woman’s needs and admitted her to a 150-bed recovery care center for the homeless in Fullerton, Orange County. She was covered by women’s Medicaid health insurance. Staff connected her to her primary care physician and oncologist to arrange her chemotherapy. She is currently receiving treatment and her condition is stable. She will continue to receive recovery care while staff work to find her a permanent home, according to the foundation’s co-CEO, DNP Poojavara.
An estimated 580,000 people leave their homes every night in the United States. When they are injured or recovering from surgery or serious illness, there is no safe place to recuperate. They may give you public transport passes or tell you to take a rest at the public library. Homeless patients often return to hospital emergency departments or are readmitted. Health outcomes are worse and health care costs are higher than those with housing.
In response, community health centers, homeless shelters, hospitals, and other organizations have launched 133 medical respite programs, including those used by women in Orange County, for homeless people in 35 states and the District of Columbia. It was started. , according to Dr. Barbara DiPietro, Senior Policy Director for National Health Care at the Homeless Council.
There is more than one way to operate a respite program. Some programs, especially those affiliated with hospitals and clinics, are staffed by licensed medical professionals. Others use unlicensed staff and bring in doctors, nurses and therapists to provide care. accept.
“We believe the value is very clear in terms of avoiding readmissions, providing better care, and giving people a chance to recover.” Medicaid Managed Care and Medicare Advantage Plans We operate.
hindrance
However, there are too few of these programs to serve all the homeless people across the country who need housing and support while recuperating. Many factors are limiting their growth, experts say. Getting state approval to cover these services for Medicaid plans is a cumbersome process, and many plans have not yet paid for it. It requires the cooperation of community stakeholders, which can be difficult. Furthermore, there are still no firm national data showing that these programs result in overall cost savings and improved outcomes. However, a 2021 literature review published by the National Institute for Medical Respite Care found that Without it, homeless patients spend longer in hospitals, with sub-optimal outcomes, and respite care has been shown to reduce hospital costs.
“It’s complicated, time-consuming, and requires extensive thinking about how to work with partners,” said Karen Dale, CEO of Colombia’s AmeriHealth Caritas District. Another hurdle for her is that Medicaid’s plan “worries that if they invest and do all this work and that person is no longer a member, someone else will benefit.” she says.
In addition, 12 states have not yet expanded Medicaid under the Affordable Care Act, and since Medicaid is the primary source of coverage for the homeless, respite for the homeless in those states. It has become much more difficult for programs to fund their services.
Tennessee has not expanded Medicaid, so “people in our uninhabited communities are using the emergency room as their primary care provider, driving up costs,” says Nashville. says Julia Sutherland, executive director of The Village at Glencliffe, a medical respite program for homeless people in the neighborhood. “That means we spend hours sitting with families in the ER, helping them find housing, benefits, jobs, taking them to eye doctors, and so on.”
With no Medicaid reimbursement, her program relies on support from the church it sponsors, contracting local hospitals to serve discharged patients in 12 private homes in the church’s former parking lot. doing. However, the lack of compensation makes it very difficult for participants to obtain substance use treatment. “It’s hard to tell people who need help that they have to wait,” Sutherland said.
light the way
Illumination started a medical respite program for homeless people 12 years ago. That’s when leaders at the Orange He County’s local hospital realized they needed a safe place to discharge the homeless, explains Barra. They asked Illumination to start the program.
The Foundation built a 150-bed facility in Fullerton, with an affiliated medical facility on the second floor staffed by doctors and nurses, including a psychiatrist. Also in Riverside County, he established a 50-bed stand-alone facility to support recovery care at motels in Los Angeles County.
Encouraged by the California Advancing and Innovating Medi-Cal Program, many Medicaid plans have agreed to reimburse funds for the housing, case management, behavioral health and substance use treatment they provide. They see evidence that the program improves enrollment outcomes and reduces costs.
For example, a study conducted by Illumination in partnership with Cal Optima found that annual emergency room visits by homeless people enrolled in Cal Optima health insurance decreased by 22%, and one year after completion of services at Illumination Hospital admissions decreased by 26%. Total monthly cost per member he decreased by 23%.
While some Medicaid plans, such as CalOptima, approve applicants for the Foundation’s respite program quickly, others, especially in Los Angeles County, are stingy about approvals, says Bhalla. “Our beds remain empty because these plans don’t refer patients,” she said. .”
Currently, at least seven medical respite programs in five states receive payment from Medicaid plans, and at least three states (California, Utah, and Washington) say they are moving to have them covered as standard benefits under their Medicaid programs. , says DiPietro.
Medicaid reimbursement
Medicaid plans reimburse respite programs in a variety of ways. Her Yakima Neighborhood Health Services, a federally accredited health center in Washington state that launched the respite program in 2010, receives a capped per diem per patient per year from one plan, she said. CEO Ronda Hauff said. Her two other plans pay for case rates either at a per-patient annual cap or at her two-year cap, she says.
The average cost of respite services at the Yakima Program’s two 5-bed facilities is $140-$160 per day. This does not include primary and behavioral care provided in clinics. Add those up and you get $350 to $400 per day. Three of the four Medicaid plans serving the Yakima area of downtown Washington voluntarily agreed to cover the service. “The state is trying to get people out of hospitals[with the Medicaid plan],” Berge points out. “It makes a lot of sense to develop these alternative settings.”
Hauff found that medical respite can be a gateway for homeless people who previously denied medical and behavioral care, shelter and other services. “It’s often the most vulnerable time in your life, especially when you’re feeling vulnerable,” she says. “When they start feeling better, they ask our staff to help them find stable housing, employment, clothing, benefits like disability. That’s the road to recovery.” A major problem for other programs is the lack of permanent housing places, with many clients returning to the streets or shelters. do not have sufficient resting capacity to help recover from acute conditions,” Hauff said.
DC program
AmeriHealth Caritas DC adopted a medical respite approach after Washington, DC’s Medicaid agency moved in 2016 to performance-based contracts that penalize plans for excessive readmissions and emergency department visits. But Dale said the effort was largely driven by a desire to improve healthcare and reduce inequality for the poor in DC.
Since opening, Hope Has a Home has served 161 male patients referred by local hospitals in two eight-bed facilities, Dale says. Investments in preventable hospitalizations, 30-day all-cause readmissions, and reduced low vision emergency room visits. Dale says her current goal is to open additional facilities for women, including pregnant women.
“Medical rest is a great solution for addressing the social determinants of health,” she comments. “More insurers need to investigate to build a healthcare delivery system in many places.”
Harris Meyer is a freelance journalist covering healthcare in Chicago.
