Post on 16-Jan-2016
transcript
Hospital Discharge of
Homeless Persons in Chicago
2000 - 2006
National Alliance to End Homelessness Annual Conference
2006
Arturo Valdivia BendixenAssociate Director
AIDS Foundation of Chicagoabendixen@aidschicago.org
Presentation• The Interfaith House Experience
• Snapshot Study of Cook County Hospital – 2006
• Integrating Systems of Care
• The CHHP Experience
Interfaith House• 64 bed respite care facility
• Hospital referrals from hospital discharge social workers
• At capacity most of the time
• 3 largest referral sources:
- Cook County Hospital (Stroger)
- Mt. Sinai Hospital
- West Side VA Hospital
Study of Discharges to Respite Care
Dr. David Buchanan
Service Respite Care Usual Group
• Inpatient Days: mean: 3.4 mean: 8.1
• ER Visits: mean: 1.4 mean: 2.2
• Outpatient Vts: mean: 6.7 mean: 6.0
Hospital Discharges
• Interfaith House
• Variety of Shelters
• Temporarily with family / friends
• Some discharged to the streets
• Some placed inappropriately at nursing homes
Prevalence of the Homelessat Cook County Hospital - 2006
Dr. David Buchanan
Snapshot of inpatients at hospital:• Homeless (HUD definition): 19.8%
• Doubled-up homeless: 12.6%
TOTAL: 32.4%
• Mean duration of homelessness: 15.6 months
Homelessness =THE FAILURE OF
MULTIPLE SYSTEMS OF
CARE
Chicago Area• No tracking of the homeless at hospitals• No designated social workers to serve the
homeless• Expedited hospital discharges often
result in poor referrals and placements• Poor integration of hospital social
services with shelter or housing systems
Organizational Partners
• 3 Key Medical Centers / Hospitals
• 11 Supportive Housing Providers
• 3 Respite/Interim Housing Providers
• 7+ Health Care Foundations
• HUD / HOPWA
Client Partners
• Adults who are homeless
• In-patient at 3 area hospitals
• At least 1 chronic medical illness
• Willingness to give consent
4-Year Demonstration & Research Project
Sept. 2003 to Aug. 2007
First of Chicago’s Plan to End Homelessness
CHHP Project Design
• Systems Integration - Council of Executive Directors
- Oversight Committee of Directors
- Systems Integration Team of Social Workers and Case Managers
- Integrated Funding Opportunities
CHHP Project Design
• Hospital
• Respite Program
• Permanent Housing
Systems Integration Team
Serving the Intervention Group
• Hospital: 2 case managers• Interim/Respite Housing: 3 case managers• Housing: 10 case managers• Coordination: 1 coordinator
Project Design - Housing
• Supportive Housing – variety of models
• Intensive Case Management – 10:1 ratio
• “Housing First” approach
• “Harm Reduction” models
• Research Component
CHHP ParticipantsJune 30, 2006 – Final Enrollment
• Intervention: 216
• Usual Care: 220
• TOTAL: 436
CHHP “Intervention”
Participants
Intervention GroupEnrollment
Began September 2003
Concluded May 2006
Intervention GroupTop Multiple Diagnoses - 216 Participants
HIV/AIDS 75 participants 34%
Hypertension 73 participants 33%
Cardiovascular Diseases 33 participants 14%
Pulmonary Diseases 39 participants 18%
Diabetes 32 participants 14%
Gastrointestinal / Liver 14 participants 6%
Seizure Disorders 18 participants 8%
Intervention GroupGender – 216 Participants
0
10
20
30
40
50
60
70
80
Male TransG
Gender
• Male: 74%
- 159 participants• Female: 25%
- 56 participants• Transgender: 1%
- 1 participant
Intervention GroupAge – 216 Participants
0
10
20
30
40
50
60
70
21+ 41+ 61+
Age
• 21 - 40: 30% - 64 participants
• 41 - 60: 64% - 140 participants
• 61 - 82: 6% - 12 participants
• MEDIAN: 47 years
Intervention GroupRace/Ethnicity – 216 Participants
0
10
20
30
40
50
60
70
80
Race/Eth
• African A / Black: 77%
- 166 participants
• Hispanic / Latino: 8%
- 17 participants
• Caucasian / White: 10%
- 22 participants
• Other: 5%
- 11 participants
Long-Term Homelessness216 Participants
• Long-Term Homelessness (HUD)
151 participants - 70%
• Short-Term Homelessness
65 participants - 30%
Substance Use History216 Participants
• Assessed with Long Term History
153 participants - 71%• Estimated with Long-Term History
186 participants - 86%
Mental Illness History216 Participants
• Diagnosed with Long Term History
67 participants - 31%
• Estimated with Long-Term History
99 participants - 46%
Stably Housed
Reached Stable HousingIntervention Group – 11/03 to 6/06
• 75% are reaching permanent housing
• 60% are remaining housed for 1+ year
Housed Less Than 1 YearJune 2006
• 11 died in stable housing
• 2 went nursing home (terminal illness)
• 5 went to prison / jail
• 13 lost housing – eviction, illegal or violent behavior
Reached Stable HousingIntervention Group – 11/03 to 6/06
Length of days to reach housing after hospital discharge-
• Average: 76 days
• Range: 70 – 90 days / {outliers: 0 – 371 days}
• Median: 62 days
1+ Year HousedMISA Issues
• Substance Use History – 60% • Mental Illness History – 10% • MISA History - 20%
Not Achieved Stable Housing25%
Common Challenges
• 50% disengaged after hospital discharge• Serious mental illness history with
neuropsychiatry issues for some• Serious MISA histories• Felony histories – esp. sex offenders• Chronic illness complications – in nursing
homes• Death before housing placement• Return to jail or prison
Preliminary OutcomesJune 2006
Nursing Home Days
Intervention Group:
• 2,146 days
Usual Care Group:
• 6,553 days0
1000
2000
3000
4000
5000
6000
7000
Days
Intervention Usual Care
Preliminary OutcomesJune 2006
0
0.5
1
1.5
2
2.5
3
3.5
4
Visits
Intervetion Usual Care
Emergency Room Visits
Intervention Group• 2.5 times less
(mean: 1.6)
Usual Care Group• 2.5 times more
(mean: 4.0)
Preliminary OutcomesJune 2006
HospitalizationsIntervention Group:
• Mean: 1.5
Usual Care Group:
• Mean: 2.30
0.5
1
1.5
2
2.5
Hospitalizations
InterventionUsual Care