Hospital Discharge of Homeless Persons in Chicago

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Hospital Discharge of
Homeless Persons in Chicago

• 2000 - 2006

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National Alliance to End Homelessness Annual
Conference2006

• Arturo Valdivia Bendixen
• Associate Director
• AIDS Foundation of Chicago
• abendixen_at_aidschicago.org

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Presentation

• The Interfaith House Experience
• Snapshot Study of Cook County Hospital 2006
• Integrating Systems of Care
• The CHHP Experience

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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

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Study of Discharges to Respite CareDr. 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

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Hospital Discharges

• Interfaith House
• Variety of Shelters
• Temporarily with family / friends
• Some discharged to the streets
• Some placed inappropriately at nursing homes

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Prevalence of the Homelessat Cook County
Hospital - 2006Dr. 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

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Homelessness

• THE FAILURE OF MULTIPLE SYSTEMS OF CARE

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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

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(No Transcript)
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Organizational Partners

• 3 Key Medical Centers / Hospitals
• 11 Supportive Housing Providers
• 3 Respite/Interim Housing Providers
• 7 Health Care Foundations
• HUD / HOPWA

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Client Partners

• Adults who are homeless
• In-patient at 3 area hospitals
• At least 1 chronic medical illness
• Willingness to give consent

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4-Year Demonstration Research ProjectSept.
2003 to Aug. 2007

• First of Chicagos Plan to End Homelessness

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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

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CHHP Project Design

• Hospital
• Respite Program
• Permanent Housing

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Systems Integration TeamServing the Intervention
Group

• Hospital 2
  case managers
• Interim/Respite Housing 3 case managers
• Housing 10 case managers
• Coordination 1
  coordinator

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Project Design - Housing

• Supportive Housing variety of models
• Intensive Case Management 101 ratio
• Housing First approach
• Harm Reduction models
• Research Component

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CHHP ParticipantsJune 30, 2006 Final Enrollment

• Intervention 216
• Usual Care 220
• TOTAL 436

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CHHP Intervention Participants
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Intervention GroupEnrollment

• Began September 2003
• Concluded May 2006

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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
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Intervention GroupGender 216 Participants

• Male 74
• - 159 participants
• Female 25
• - 56 participants
• Transgender 1
• - 1 participant

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Intervention GroupAge 216 Participants

• 21 - 40 30
• - 64 participants
• 41 - 60 64
• - 140 participants
• 61 - 82 6
• - 12 participants
• MEDIAN 47 years

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Intervention GroupRace/Ethnicity 216
Participants

• African A / Black 77
• - 166 participants
• Hispanic / Latino 8
• - 17 participants
• Caucasian / White 10
• - 22 participants
• Other 5
• - 11 participants

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Long-Term Homelessness216 Participants

• Long-Term Homelessness (HUD)
• 151 participants - 70
• Short-Term Homelessness
• 65 participants - 30

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Substance Use History216 Participants

• Assessed with Long Term History
• 153 participants - 71
• Estimated with Long-Term History
• 186 participants - 86

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Mental Illness History216 Participants

• Diagnosed with Long Term History
• 67 participants - 31
• Estimated with Long-Term History
• 99 participants - 46

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Stably Housed
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Reached Stable HousingIntervention Group 11/03
to 6/06

• 75 are reaching permanent housing
• 60 are remaining housed for 1 year

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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

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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

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1 Year HousedMISA Issues

• Substance Use History 60
• Mental Illness History 10
• MISA History - 20

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Not Achieved Stable Housing25Common 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

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Preliminary OutcomesJune 2006

• Nursing Home Days
• Intervention Group
• 2,146 days
• Usual Care Group
• 6,553 days

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Preliminary OutcomesJune 2006

• Emergency Room Visits
• Intervention Group
• 2.5 times less
• (mean 1.6)
• Usual Care Group
• 2.5 times more (mean 4.0)

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Preliminary OutcomesJune 2006

• Hospitalizations
• Intervention Group
• Mean 1.5
• Usual Care Group
• Mean 2.3