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Health Care for the Homeless:the Basics
CHE/Trinity Homeless Champions Webinar #1
October 14, 2014
Introduction:Doreen Fadus, CBMO, Mercy Medical Center, Springfield MA
Presenters:John Lozier, Executive Director, National HCH Council, Nashville
TNHeidi Nelson, CEO, Duffy Health Center, Hyannis MA
Catholic Social TeachingA basic moral test is how our most vulnerable members are faring. In a society marred by deepening divisions between rich and poor, our tradition recalls the story of the Last Judgment (Mt 25:31-46) and instructs us to put the needs of the poor and vulnerable first.
http://www.usccb.org/beliefs-and-teachings/what-we-believe/catholic-social-teaching/seven-themes-of-catholic-social-teaching.cfm
130 Organizational Members, including:•St. Joseph’s Mercy Care, Atlanta GA•Mercy Medical Center, Springfield MAHCH Clinicians’ NetworkNational Consumer Advisory BoardRespite Care Providers’ NetworkPractice-Based Research Network
Funding:•National Cooperative Agreement with HRSA to
provide training & TA to 255 HCH grantees and others•2 HCIA awards from CMS (studying Community Health
Workers and Medical Respite Care)•Additional public and private support
The mission of the National Health Care for the Homeless Council is to eliminate homelessness by ensuring comprehensive health care and secure housing for everyone.
The National Health Care for the Homeless Council was founded on the principles that•homelessness is unacceptable;•every person has the right to adequate food, housing, clothing, and health care;•all people have the right to participate in the decisions affecting their lives;•contemporary homelessness is the product of conscious social and economic policy decisions that have retreated from a commitment to insuring basic life necessities for all people; and•the struggle to end homelessness and alleviate its consequences takes many forms, including efforts to insure adequate housing, health care, and access to meaningful work.
Who is Homeless?A homeless person is an individual without
permanent housing who may live on the streets, stay in a shelter, mission, single room
occupancy facilities, abandoned building or vehicle, or in any other unstable or non-
permanent situation. A recognition of the instability of an individual's living arrangements is critical to the definition of homelessness.
*Bureau of Primary Health Care
Please Use These Diagnosis Codes for
HomelessnessICD-9-CM: v60.0 ICD-10-CM: Z59.0
REFERENCE TERMS:Hobo
Lack of housing, shelterSocial Migrant
NomadTramp
TransientVagabondVagrant
Causes of Homelessness
Housing Costs+
Insufficient incomes
=Homelessness
In the United States, the 2014 two-bedroom Housing Wage is $18.92. This national average is more than two-and-a-half times the federal minimum wage, and 52% higher than it was in 2000. In no state can a full-time minimum wage worker afford a one-bedroom or a two-bedroom rental unit at Fair Market Rent.
-National Low Income Housing CoalitionOut of Reach 2014 http://nlihc.org/oor/2014
Causes of Homelessness
Poor health causes homelessness–Financial impact (medical bankruptcy)–Personal Impact (behavioral health -> exclusion)–Effects of Trauma
A Second Relationship Between Homelessness &
HealthHomelessness causes poor health– Exposure to elements, communicable
disease, violence, parasites – Poor nutrition– Poor sleep/rest• Criminalization of homelessness
– Exacerbation of existing conditions– Self-medication & depression
A Third Relationship Between Homelessness & Health
Homelessness interferes with treatment– Competing priorities– Adherence difficulties– Transportation– Uninsurance
Institute of Medicine, Homelessness, Health, and Human Needs. Washington: National Academy Press, 1988.
CONSEQUENCES• Pervasive homelessness• High rates of illnesses (3-6 times)• Multiple complex morbidities• Premature mortality (30 years)• Deferred care/high costs• Inappropriate ER utilization• Discharge difficulties
Health Care for the Homeless Grantees
http://www.nhchc.org/resources/grantees/national-hch-grantee-directory/
Training & Technical Assistance
• National HCH Conference–Washington DC, May 7-9, 2015
• Eastern Regional Training– New York City, March 19-20, 2015
• Live and archived webinars– http://www.nhchc.org/cat/webinars/
• Technical Assistance
Community BenefitNeeds assessment resources
Toolkit: Assessing Your Community’s Health: A Needs Assessment Toolkit for HCH Grantees
http://www.nhchc.org/wp-content/uploads/2014/02/chna-toolkit_final_2-21-14.pdf
Webinar: HRSA Needs Assessment for HCH Grantees
http://www.nhchc.org/2013/09/homeless-persons-memorial-day-2014/
Community benefit examples
The HCH Approach to Care• PCMH – Patient-Centered Medical
Homes • Coordination of Care• Multidisciplinary Teams• Access– Street outreach– Accessible locations & hours– Elimination of financial barriers
• Patient Self-determination Goal Setting
Evidence-Based HCH Practices
• Motivational Interviewing• Trauma Informed Care• Harm Reduction• Cultural Competency
Promising Practice:• Medical Respite Care
http://www.nhchc.org/resources/clinical/medical-respite/
Adapted Clinical Guidelines• Asthma• Cardiovascular Diseases: Hypertension, Hyperlipidemi
a & Heart Failure• Chlamydial or Gonococcal Infections • Chronic Pain• Diabetes Mellitus • General Recommendations for the Care of Homeless
Patients• HIV/AIDS• Opioid Use Disorder• Otitis Media• Reproductive Health Care
http://www.nhchc.org/resources/clinical/adapted-clinical-guidelines/
Coming in this Champions Series
Nov. 13, 2014 Redirecting Frequent Users from Emergency Rooms to Primary Care
Dec. 11, 2014Medical Care on the Streets: Homeless Outreach
Jan. 13, 2015Care Transitions: Hospital Discharge and Medical Respite Care
Feb. 12, 2015Payment Challenges
Mar. 12, 2015 Housing & Health Care
All 3:00 – 4:00 pm Eastern