When I was with Park Center, WillyC and I tried to establish a relationship with area hospitals to improve aftercare and discharge plans for folks experiencing homelessness.
While the facilities were eager to work with us, the big problem was, of course, the lack of available respite care for indigent individuals.
The Campus for Human Development's new building will definitely help to ease this problem, but even so it is going to take some time to get everyone on the same page.
Still, this new building will put some light at the end of the tunnel, so to speak, so that folks being discharged will have some place to go besides the streets....
Keeping homeless healthy
Management team looks at ways to improve hospital discharge services
By Brock Letchworth The Daily Reflector
Wednesday, May 13, 2009
Organizers of a 10-year plan aimed at ending chronic homelessness in the county say improving discharge policies for homeless individuals leaving health care facilities figures to be an important factor if the plan is going to be successful.
Now they just have to figure out the ways to do that.
The management advisory team of the coalition developing the plan recently heard from a Brody School of Medicine graduate who, for a school assignment earlier this year, spent months researching discharge planning in hospitals.
Lauren Welsh, a Washington, N.C., native, used interviews with physicians and social workers at Pitt County Memorial Hospital and research from various agencies nationwide to illustrate how proper discharge planning can benefit the bottom line for health care facilities and the overall health of the community.
Welsh told the group that her research revealed no discharge planning guidelines for homeless patients at PCMH and the need for more staff education about local resources available to help with the process.
“When you look at the research, you realize that it is surprisingly advantageous to implement a policy to prevent the loss of homeless patients if you don't have homeless patient discharge planning,” Welsh said. ”With homeless patients, there is an increased length of stay. They drain the hospital from the bottom, technically, with emergency room in and out, revolving door medicine.
It is not intuitive that if you kick them out the door as fast as you can without proper planning, they will be back revolving through the emergency room services. We need that mentality to change and hospitals have to start realizing that it is not financially worth it for the health or money to release patients without proper discharge planning.”
Tom Czaplijski, vice president for operations at PCMH, said the hospital does not have a specific policy for discharging homeless patients and officials there evaluate, assess and manage everyone the same.
By law, hospitals are required to have a discharge planning process for all patients in order to receive Medicaid and Medicare reimbursements. That includes the identification of all patients who are likely to suffer adverse health consequences upon discharge without adequate planning. Welsh believes those patients include the homeless.
Czaplijski said the lifestyle of a homeless person often makes it difficult to track them and ensure a proper follow-up service. He noted that the hospital does not discharge anyone if they can't connect them with a follow-up service or they feel they have no safe place to go.
“We do everything we can to make sure it is a safe discharge and they are hooked up to the resources they need when they leave here,” Czaplijski said. “From that point, it is sort of up to the individual to follow through. One of the things we assess is that someone has the capacity and the ability to make decisions for themselves. Like any other patient in our hospital, if you are competent and capable of making decisions for yourself and you choose to go back to a lifestyle of being homeless or not wanting us to know where you are going, we don't have a means or right to stop you. We give them a plan and ensure that if they have ongoing health needs we set that up for them just like any other patient, but just like any other patient, once they leave here we can't force them to follow through or do the things we suggest or tell them they need to do.”
Welsh recommended a couple of approaches that have worked in other areas, including a hospital consulting service like Operation Safety Net in Pittsburgh which connects staff members with patients upon admission and sends them into the field to ensure proper care after they leave. She also noted the benefits of offering respite care or permanent supportive housing and the effectiveness of programs like S.O.A.R. which provide assistance to individuals filling out disability and social security applications.
Pitt County Homeless Management Information Strategies Coordinator Paulette White, a member of the 10-year plan's management advisory team, said discharge planning is among several components of the plan that officials have already been examining.
“If we can develop a system to help these people that we know are being discharged from places with nowhere to go, then we can go a long way toward lowering these overall expenses related to them,” White said.
Lynne James, executive director of the Greenville Community Shelters, said issues with discharge planning are not limited to hospitals. Jails and mental health facilities face similar challenges.
James noted that the area needs more housing resources before the issue can be adequately addressed.
She said some of the approaches planners are considering to improve discharge planning including more use of the S.O.A.R. program and contracting with apartment complexes to obtain places for discharged homeless individuals to stay until they are healthy and back on their feet.
“It seems that would be better than having some apartment units sitting there vacant,” James said.
The officials' implementation of the 10-year Plan to End Chronic Homelessness begins July 1.
Contact Brock Letchworth at bletchworth@coxnc.com or (252) 329-9574.
