In Chicago, Northwestern Memorial Hospital works with Interfaith House for its patients who are homeless. In January, the hospital began contracting with Interfaith to provide two beds to homeless patients discharged from their facility. Jessica Soos Pawlowski, patient-care manager at the 885-bed hospital, said her facility treats about 100 homeless patients on average per month, many of whom would benefit from medical respite services. But it's hard to find placements for them because homeless shelters are usually full and have lengthy wait lists. In addition, Interfaith provides services that go beyond those that most homeless shelters offer, with oversight by health professionals.
Pawlowski estimates it costs Northwestern about $500,000 a year to treat its patients who are homeless, and expects the contract with Interfaith to save the hospital about $100,000 in the first year. “This partnership helps better manage and secure the right care setting for longer-term healing,” she said.
Interfaith's Assessment/ Respite program receives more than half its funding from the U.S. Department of Housing and Urban Development. Once there, patients are assigned a case manager who provides medical oversight. A clinician assesses and monitors their condition, makes sure they are complying with medical orders, and provides basic medical care, such as wound treatment, when needed. Case managers also help patients find a primary-care physician, apply for Medicaid, and get counseling for issues involving behavioral disorders and substance abuse. The goal is to prepare them to transition into stable housing.
While Chicago-area hospitals have referred their homeless patients to Interfaith for years, Interfaith only recently has begun talking to hospitals about signing contracts for its services. So far, Northwestern is the only health system contracting with Interfaith, though talks with other hospitals have been promising, said Jennifer Nelson-Seals, executive director for Interfaith House. “Hospitals … are starting to listen to us,” she said.
In Atlanta, Mercy Care Services, part of the St. Joseph Health System, in 2008 launched its Recuperative Care program, a 19-bed facility that operates out of a converted prison. Hospitals refer homeless patients to Mercy Care, where they can finish their recovery. Mark Meyer, executive vice president and chief financial officer of Atlanta's Grady Health System, estimated the program could save Grady Memorial Hospital as much as $500,000 a year for each acute-care bed that was freed up and then filled with an insured patient. “If you can get someone some shelter, and provide them with some care and three meals a day, then that will certainly reduce readmissions to the hospital,” he said.
Hospitals participating in accountable care arrangements will increasingly see the value in partnering with medical respite groups to control the costs of serving homeless patients, said Mercy Care CEO Thomas Andrews. “I think slowly (hospitals) are starting to get the fact that they need to have relationships with programs like this that do a good job of keeping people out of the hospital,” Andrews said. “As they start taking on risk for different populations, maybe we would see some opportunity for them to contact us to pay us for this service.”
Medical respite programs need that kind of sustainable financial support to keep going, rather than one-time government or charitable grants, Nelson-Seals said. And the federal and state governments need to see housing support as a key part of healthcare reform. “Housing is healthcare,” she said.
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